Sudden death from metastatic esophageal cancer to the ventricular septum

A 67-year-old man was admitted to our hospital due to esophageal cancer. Cancer existed at the lower esophagus and subtotal esophagectomy and lymphadenectomy was performed. The postoperative course was uneventful. Pathological findings revealed moderately differentiated squamous cell carcinoma that metastasized to the abdominal lymph nodes which include the paraaortic lymph nodes. He complained of anorexia three months after the operation and was found to have multiple liver and mediastinal lymph node metastases. He was admitted for chemotherapy. Before starting chemotherapy, he suddenly died without any sign of hemorrhage or respiratory disorder. Autopsy showed metastatic lesions to the heart and mediastinal lymph nodes, liver, thoracic vertebrae, kidney, adrenal gland and heart. Metastatic nodules in the heart were on the ventricular septum where the conducting system exists. No direct invasion from the pericardium was observed. Blockade of the conducting system of the heart was considered to have caused the severe arrhythmia and sudden cardiac arrest.     

Lung cancer with both sarcoid reaction and metastasis in the mediastinal lymph nodes; report of a case

A 66-year-old man was admitted to our hospital for detailed investigation of an abnormal shadow on his chest X-ray. Chest radiography and computed tomography(CT) of the chest showed mediastinal lymphadenopathy and a tumor shadow in the left upper lobe. Biopsy of the mediastinal lymph nodes by mediastinoscopy showed that sarcoid nodules existed in all the biopsies nodes. Therefore, the lymphadenopathy was thought to be sarcoidosis or sarcoid reaction accompanied with lung cancer. Left upper lobectomy and dissection of hilar and mediastinal lymph nodes were performed. Although sarcoid nodules were seen in all the dissected lymph nodes, the cancer involved #5 and #14 lymph nodes. He died of brain metastasis 10 months after surgery.     

A case of advanced paratesticular rhabdomyosarcoma

A case of paratesticular rhabdomyosarcoma is presented. An 18-year-old male was admitted with the complaint of giant scrotal swelling and abdominal fullness on September 5, 1986. Left radical orchiectomy was performed with the pathologic diagnosis of alveolar rhabdomyosarcoma. The tumor was paratesticular in location and had invaded a spermatic cord. Radiological examination showed a gross metastatic mass in retroperitoneal lymph nodes, supraclavicular lymph nodes and Douglas pouch. The patient received induction chemotherapy containing vincristine, actinomycin-D, cyclophosphamide, bleomycin, CDDP and VP-16. After 3 courses, he had no mass in Douglas pouch and supraclavicular lesion. He received retroperitoneal lymph node dissection for residual retroperitoneal mass, and postoperative radiotherapy was given. However, recurrent disease was developed in the paraaortic region with malignant ascites. He was treated with salvage chemotherapy, had without any significant effect. He died of liver dysfunction due to progressive mass in hepatic hilum. A review of the current approach of paratesticular rhabdomyosarcoma with the usefulness of combination chemotherapy is given.     

Induction chemoradiotherapy in small adenocarcinoma of the lung with bulky mediatinal lymph node metastasis

A 56-year-old man, who visited our hospital due to chest pain, was pointed out a large tumor, 60 mm in diameter, on the left superior mediastinum on the chest computed tomography (CT) scan. He was diagnosed as having mediastinal lymph nodes metastasis of adenocarcinoma through video-assisted thoracoscopic surgery (VATS) biopsy. He received induction chemoradiotherapy: cisplatin and paclitaxel were administered once per week for 2 weeks, and radiotherapy was simultaneously performed. No serious adverse reactions were noted. The ipsilateral mediastinal lymph nodes dissection was performed. Intraoperative frozen section analysis showed a small nodule in the left upper lobe, 5 mm in diameter, was adenocarcinoma. He was finally diagnosed as having mediastinal lymph nodes metastasis from the small adenocarcinoma of the lung, and left upper lobectomy was performed. Histopathological examination of the mediastinal lymph nodes showed no evidence of viable maligmant cell. Induction chemoradiotherapy with cisplatin and paclitaxel might be effective treatment for locally advanced non-small cell lung cancer.     

A case of unknown origin cancer of the mediastinal lymph node]

We encountered an unusual case with a sole cancer focus at the mediastinal lymph node. The patient was a 44-year-old man who visited our department with a chief complaint of chest pain. Subsequent chest X-ray and CT revealed an enlargement of a mediastinal lymph node. The excised lymph node measured 6.8 x 5.5 x 4.0 cm and weighed 51 g. It showed metastasis of poorly differentiated adenocarcinoma. In spite of a thorough systemic examination, no primary foci were detected. Lymph node tumors of the mediastinum or hilar region with unknown primary foci are extremely rare (there have been only 2 reported cases of lesions found at the hilar lymph node with unknown primary focus). There have been no reports on cancerous foci limited to the mediastinal lymph nodes. The patient has been under chemotherapy and radiotherapy during the past 3 years following surgery. He shows no signs of recurrence. It is a very unusual case. A possible classification of T0N2M0 has been considered.     

A case of squamous cell carcinoma of the thymus

A case of squamous cell carcinoma of the thymus was reported. A 60-year-old female was admitted because of swelling of left cervical and left axillary lymph nodes. Chest X-ray revealed left anterior mediastinal mass shadow. The histological examination on the excised left axillary lymph nodes revealed well differentiated squamous cell carcinoma. After radiotherapy, the operation was performed with median sternotomy and then the mediastinal tumor was diagnosed squamous cell carcinoma originated from the thymus. The postoperative course of the patient was unfavorable, though adjacent postoperative radiotherapy and chemotherapy. Compared with ordinary thymoma, squamous cell carcinoma of the thymus commonly metastasizes outside the thorax and has poor prognosis. In view of these differences, it should be separated histologically from ordinary thymoma.     

A case of bronchial mucoepidermoid carcinoma in a 8-year-old child treated with right upper sleeve lobectomy

A 8-year-old boy was admitted to our hospital with complaint of cough and abnormal shadow on chest X-ray. Bronchoscopy and biopsy revealed a bronchial mucoepidermoid carcinoma, which obstructed right main bronchus. Right upper sleeve lobectomy was performed. The histological examination revealed a low grade malignant mucoepidermoid carcinoma. There were no metastases in the mediastinal lymph nodes. He has been healthy with no evidence of recurrence during 4 years after operation.     

Long-term survival cases of lung cancer presented as solitary bone metastasis.

The prognosis of non-small cell lung carcinoma (NSCLC) with bone metastasis has been regarded as very poor. We report herein on two cases of NSCLC which presented as a solitary bone metastasis, were treated with surgical resection. Both these cases survived for over 5 years after their last operations. A 71-year-old-man was hospitalized with right crural pain. A diagnosis of squamous cell carcinoma of the left lower lobe with right fibula metastasis was made. A marginal resection of the right fibula was performed. After that, a left lower lobe lobectomy and systemic chemotherapy were carried out. He had a local recurrence in the right mediastinal lymph nodes eleven months after the operation. He received intraluminal and external radiation therapy and obtained complete remission. He has survived for 5 years without any other recurrence or metastasis. A 52-year-old-man was admitted to our hospital with left thigh pain. A diagnosis of adenocarcinoma of the right upper lobe with left thigh metastasis was made. A right upper lobe lobectomy and a resection of the left thigh tumor were performed. Three cycles of systemic chemotherapy were given after that. He has survived for 5 years since his last operation without any recurrence or metastasis.     

Legionnaires' disease with mediastinal lymph nodes swelling, diagnosed by open lung biopsy--a case report

Legionnaires' disease in a 37-year-old male who had had silicosis was reported. He was admitted because of dyspnea. The chest X-ray film and CT scan showed infiltrative shadow and swelling of mediastinal lymph nodes. Open lung biopsy was done and Legionella pneumohila was detected. REP and EM were started and infiltrative shadow of X-ray was disappeared. Pleuro-pneumonectomy and thoracoplasty were performed because of hemoptysis and postoperative empyema. The patient is now well.     

Thymic carcinoid with lymph node metastases; report of a case

A 71-year-old man was admitted to our hospital because of the detection of an anterior mediastinal tumor. Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed abnormal accumulations in the tumor and the hilar and the supra-clavicular lymph nodes. Preoperatively, percutaneous needle biopsy of the tumor revealed thymic carcinoid. Tumor resection and thymectomy with mediastinal and supra-clavicular lymph nodes dissection were performed because of suspecting metastasis to the lymph nodes from FDG-PET. Postoperative pathological diagnosis revealed atypical carcinoid and metastases to the mediastinal and supra-clavicular lymph nodes. In our case, FDG-PET was useful in detecting the thymic carcinoid and lymph node metastasis. It is desirable to perform clinical research by many facilities for the assessment of FDG-PET as a diagnostic tool and postoperative chemo-radiation therapy for thymic carcinoid.     

A case of an anaplastic meningioma metastasizing to the mediastinal lymph nodes

Context: Grade II and III (World Health Organization classification) meningiomas rarely develop in the spinal cord. However, we experienced a case with an anaplastic meningioma that developed in the spinal cord at the cervicothoracic junction and metastasized to the mediastinal lymph nodes. No such cases have previously been reported.

Findings: The patient was a 68-year-old man who developed back pain that did not affect his daily living. He developed left lower limb paralysis, and was admitted after magnetic resonance imaging (MRI) revealed an intramedullary tumor at the level of cervical vertebra 7 and thoracic vertebra 1. Positron emission tomography revealed tracer uptake in the intramedullary tumor and the mediastinal lymph nodes, suggesting a metastatic spinal cord tumor or malignant lymphoma. A lymph node biopsy was then performed. Although the tumor was highly malignant, its primary site was not identified. Detailed examinations by several other departments revealed no abnormalities. On hospital day 30, his left lower limb paralysis deteriorated, and MRI revealed that the tumor had grown. Thus, laminaplasty, laminectomy, and tumor resection were performed. The tumor was an anaplastic meningioma that resembled mediastinal lymph node tissue, and other tumor lesions were not found. These findings suggested that an anaplastic meningioma had metastasized to the mediastinal lymph nodes. The patient did not respond to radiotherapy, and he was transferred to another hospital.

Conclusion: In cases of intramedullary spinal tumors with metastasis without other potential primary tumor lesions, early diagnosis and treatment should be performed while considering anaplastic meningioma.     

Lung cancer associated with sarcoidosis

Sarcoidosis is often identified as swollen hilar lymph nodes found in chest radiography during routine physical checkups. We report a patient with concomitant sarcoidosis and lung cancer necessitating thoracoscopic lymph node biopsy to differentiate between sarcoidosis and lung cancer as the cause of mediastinal/hilar lymph node swelling prior to conducting pulmonary lobectomy. Thoracoscopic biopsy of left mediastinal lymph nodes and sampling of frozen sections of right lymph nodes during intraoperative diagnosis did not detect metastasis. A permanent pathological slide, however, indicated that right interlobar (#11s) lymph nodes involved both sarcoidosis and lung cancer metastasis. Despite careful preparation, it thus remains difficult to distinguish between these conditions even when lymph nodes are strictly evaluated.     

Two cases of thymic carcinoma effectively treated by preoperative chemotherapy

A 67-year-old man was admitted with left pleural effusion on chest X-ray film. Chest CT scans showed an anterior mediastinal tumor, left pleural dissemination and pleural effusion. Percutaneous needle biopsy yielded a diagnosis of epitherial carcinoma. The patient underwent 3 courses of systemic chemotherapy (CDDP + ADM + VCR + CPA). At achievement of partial response, the tumor was completely resected. Examination of the resected tumor revealed partial response to chemotherapy. A 49-year-old woman was admitted our hospital with supraclavicular lymph nodes swelling. Chest CT scans showed an large mediastinal tumor. Percutaneous needle biopsy yielded a diagnosis of squamous cell carcinoma of thymus. The patient underwent 3 courses of systemic chemotherapy. At achievement of partial response, the tumor was completely resected. Examination of the resected tumor revealed partial response to chemotherapy. These cases indicate the usefulness of preoperative chemotherapy for advanced thymic carcinoma to reduce tumor size and to control local invasion, distant metastasis before operation.     

An assessment of the separation of mediastinal lymph nodes by preoperative mediastinoscopic examination as a dissecting measure in the surgical treatment of lung cancer]

The availability of the separation of mediastinal lymph nodes by preoperative mediastinoscopic examination as a dissecting measure was analyzed according to prognosis retrospectively because mediastinal lymph nodes dissection is made with ease and certainty after the examination. The separation by mediastinoscopic examination did not have an impact on the mediastinal lymph nodes dissection for carcinoma of the left lung and superior mediastinal lymph nodes metastases (# 1-4), but an influence on the dissection for carcinoma of the right lung and middle and lower mediastinal lymph nodes metastases (# 5-9). This result showed the existence of occult metastases and the good effects caused by the separation of mediastinal lymph nodes. In the histological type, the effects were present in squamous cell carcinoma and p-N0 adenocarcinoma, but it was concluded that the prognosis in adenocarcinoma was associated with other factors rather than lymph node metastasis. Therefore, it can be seen that the separation of mediastinal lymph nodes by preoperative mediastinoscopic examination is available as a dissecting measure.     

Metachronous mediastinal lymph node metastasis from ascending colon cancer: A case report and literature review

IntroductionMetachronous mediastinal lymph node metastasis without pulmonary metastasis is extremely rare in colorectal cancer, which makes the clinical diagnosis difficult and treatment strategy unclear.Prsentation of caseA case was a 59-year-old man, who had undergone right hemicolectomy for ascending colon cancer 2 years and 8 months previously, presented with enlarged mediastinal lymph nodes. ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography revealed FDG was accumulated only into the mediastinal lymph nodes. Serum carcinoembryonic antigen (CEA) level was within the normal range. Six months later, the size and FDG uptake of the mediastinal lymph nodes had increased. We assumed a possibility that the mediastinal lymph nodes were metastasized from ascending colon cancer and so performed thoracoscopic-assisted resection of the mediastinal lymph nodes. Histopathological analysis revealed the resected lymph nodes were filled with moderately differentiated adenocarcinoma and a diagnosis of mediastinal lymph nodes metastasis from previously-resected ascending colon cancer was made. The patient was postoperatively followed for more than 1 year and 8 months without any sign of recurrence.DiscussionOnly 7 cases of metachronous mediastinal lymph node metastasis from colorectal cancer, including our case, have been reported in the English literature. It is difficult to clinically diagnose mediastinal lymph node metastasis.ConclusionWe report a rare case of metachronous mediastinal lymph node metastasis from ascending colon cancer with literature review. If the mediastinal lymph nodes are enlarged after colorectal cancer resection, we need to make a treatment strategy as well as a diagnostic approach considering the possibility of mediastinal lymph node metastasis.     

Tuberculosis and mediastinoscopy.

Biopsy of lymph nodes at mediastinoscopy has been the method of diagnosis of tuberculosis in 14 patients; Mycobacterium tuberculosis was cultured from the nodes in nine cases, and in five there was histological evidence of the disease but cultural confirmation was lacking. All patients had radiographic abnormality of the superior mediastinum, and a frequent finding at mediastinoscopy was mediastinal fibrosis involving the fascia and lymph nodes. No cause other than tuberculosis could be demonstrated to account for the mediastinal fibrosis, and the patients made clinical recoveries in response to standard courses of antituberculosis chemotherapy. The development of superior vena caval compression was not observed.     

Thymic carcinoids in multiple endocrine neoplasia-type 1

We report a case of a 45-year-old man with thymic carcinoids in multiple endocrine neoplasm-type 1. Extended total thymectomy was performed through a median sternotomy, and the mediastinal regional lymph nodes and fibroadipose tissue were dissected. Multiple endocrine neoplasm-type 1 related thymic carcinoids are rare and have a poor prognosis. The efficacy of radiotherapy and chemotherapy for prolonging survival is limited, and an aggressive surgical approach with complete excision of the tumor with resection of the peripheral tissues and dissection of the mediastinal lymph nodes seems to be the best available treatment today. We have found that this practice of thymectomy at an early stage in combination with genetic and effective radiological treatment can be effective for multiple endocrine neoplasm-type 1 patients.     

Tuberculous hilar lymph nodes leading to tracheopulmonary artery fistula and pseudoaneurysm of pulmonary artery

Tracheopulmonary artery fistula is an extremely rare condition. We report the case of an 80-year-old man who presented with massive hemoptysis. He was found to have tuberculous mediastinal lymph nodes that had eroded into the pulmonary artery and anterior tracheal wall, leading to a pseudoaneurysm of the right pulmonary artery and a tracheopulmonary artery fistula.     

A case of small cell lung cancer with Waldenstrom's macroglobulinemia]

Waldenstrom's Macroglobulinemia is characterized by a proliferation of cells of the reticuloendothelial system associated with a monoclonal increase in serum levels of gamma globulins of immunoglobulin M class. We report a case of lung cancer with Waldenstrom's macroglobulinemia. A 68-year-old man was admitted to our hospital for abnormal mass shadow on chest X-P during chemotherapy for macroglobulinemia. Pathological diagnosis was small cell carcinoma by transbronchial lung biopsy. Right middle and lower lobectomy with mediastinal lymph nodes dissection were performed. Postoperative staging was stage II (t1n1m0). Chemotherapy for the lung cancer and plasmapheresis for hyperviscosity syndrome were carried out, after surgical treatment. This patient has been followed for three years and has no evidences of recurrence of the lung cancer.