Induction chemoradiotherapy prior to surgery for non-small cell lung cancer invading the left atrium.

We present a case of a 58-year-old man with diagnosis of lung adenocarcinoma invading the left atrium. He was treated with induction chemoradiotherapy for T4N1M0 disease, showing objective response. Then, a left upper lobectomy with a partial resection of the left atrium was performed without cardiopulmonary bypass. No residual tumor cells existed in the resected specimens, showing pathological complete response. Our case suggests that induction chemoradiotherapy prior to surgery can be an appropriate strategy among carefully selected patients with non-small cell lung cancer invading the left atrium.     

Anterior mediastinal tracheostomy for tracheostomal recurrence of laryngeal carcinoma

The patient was a 58-year-old male with tracheostomal recurrence after surgery for laryngeal carcinoma. After median sternotomy, half of the bilateral clavicula, the anterior portion of the bilateral 1st ribs, and the upper portion of the sternum were resected. The tumor was resected with the muscle layer of the esophagus and the left internal jugular vein. A left internal jugular vein was reconstructed from the major saphenous vein. The trachea was resected at a position of 5 rings from the carina, and then a tracheostoma was made. At an early stage after surgery, there was no problem associated with the tracheostoma. Three months after surgery, stenosis of stoma occurred, but temporary intubation of the trachea released the stenosis completely. From this result, we concluded that when anterior mediastinal tracheostomy is performed for tracheostomal recurrence with invasion to the major vessels, addition of a median sternotomy is a safe and beneficial procedure.     

Total vertebrectomy (Th2) and dissection of the subclavian artery for a superior sulcus tumor invading the spine: A case report

IntroductionSurgery for primary lung cancer invading the spine remains challenging. Here, we present a case of superior sulcus tumor (SST) with vertebral invasion, successfully resected with total vertebrectomy (Th2) and dissection of involved apical chest wall and the subclavian artery (SCA).Presentation of caseA 62-year-old man was referred with the diagnosis of lung squamous cell carcinoma originating from left upper lobe (clinical stage IIIA/T4N0M0) involving the thoracic vertebrae (Th2) as well as the apical chest wall including three ribs (1st, 2nd and 3rd) and SCA. After induction concurrent chemo-radiotherapy, we achieved complete resection by three-step surgical procedures as follows: first, the anterior portion of involved chest wall including SCA was dissected through the trans-manubrial approach (TMA); next, the posterior portion of involved chest wall including ribs was dissected and left upper lobectomy with nodal dissection was performed through posterolateral thoracotomy; finally, total vertebrectomy (Th2) was performed through posterior mid-line approach.DiscussionThis tumor was existence of anterior and posterior position in pulmonary apex region. So that, it is very important for complete resecting this complicated tumor to work out operation’s strategy.ConclusionSurgery may be indicated for SST invading the spine, when complete resection is expected.     

Giant cell tumor of the bony thorax

Two cases of giant cell tumor of the bony thorax are described. Case 1 presents a 21-year-old female with a recurrent giant cell tumor of the third and the fourth thoracic vertebrae that directly compressed the membranous portion of the trachea and brought about severe air way obstruction. The tumor was completely resected and the patient remains healthy without recurrence 30 months after surgery. Case 2 presents a 18-year-old female with a giant cell tumor invading transverse process of the seventh thoracic vertebra and the seventh rib and making a big mass in the thoracic cavity on the right side. This patient was first seen with hemothorax and treated just by tube drainage three months before undergoing total resection of the tumor. She remains well nine months after surgery.     

Combined resection of the thoracic aorta associated with subtotal esophagectomy for carcinoma of the esophagus

With recent advances in surgical techniques and post-operative care, surgical treatment of esophageal cancer has been safely performed. Nevertheless, prognoses of such cases in which the cancer is invading the ajacent aorta and when only an incomplete resection was performed are very poor. The following case in which annular resection of the thoracic aorta combined with subtotal esophagectomy was performed and an aorto-aortic bypass graft was replaced was reported. A 70 year old man came to our hospital, complaining of difficulty in swallowing. The upper GI series showed a 8 cm long filling defect in the middle esophagus. Computed tomography suggested that the tumor was directly invading the aorta. The patient underwent two staged procedure operations. During the first operation, the left chest was opened, and a side-to-end bypass graft was replaced to detour around the tumor bearing aorta with 20 mm phi Dacron Double Velour graft. The aorta was then transected. The second operation was performed through the right thoracotomy. During the operation, the thoracic esophagus and the tumor bearing aorta were resected en bloc. The patient died of hepatic failure and right pyothorax 4 months after the first operation.     

Diaphragmatic reconstruction using a latissimus dorsi muscle flap following wide resection of the diaphragm combined with esophago-gastrectomy for cardial cancer

In three patients with cardial cancer invading the esophagus and the diaphragm, wide resection of the left diaphragm and its reconstruction using a latissimus dorsi muscle flap were performed during radical esophago-gastrectomy. More than two thirds of the diaphragm could be resected because the muscle flap was large enough to be brought into the thoracic cavity without difficulty, to repair the diaphragmatic defect. The postoperative respiratory function of these patients was adequately maintained. A technique for diaphragmatic reconstruction by means of the latissimus dorsi muscle flap is described in this report.     

Surgical Treatment of a Superior Sulcus Tumor in a Patient with Idiopathic Thrombocytopenic Purpura: Report of a Case

We herein report a resection of a superior sulcus tumor in a patient with idiopathic thrombocytopenic purpura. A resection of the left upper lobe of the lung, left subclavian artery, and left first to third ribs, as well as a reconstruction of the left subclavian artery, were performed. Postoperative hemorrhaging was controlled due to preoperative high-dose intravenous immunoglobulin therapy and a platelet transfusion both during and following surgery. The resected tumor was diagnosed to be a pulmonary pleomorphic carcinoma, which was pathologically determined to be T3N0M0-Stage 2B. The patient remained in good condition for 20 months following the surgery; however, he eventually died due to bone metastases.     

Salvage esophagectomy for local recurrent esophageal cancer after definitive chemoradiotherapy followed by photodynamic therapy: A case report

IntroductionPhotodynamic therapy (PDT) is performed as a salvage treatment for patients with residual or recurrent esophageal cancer after chemoradiotherapy (CRT). Although PDT is considered less invasive than salvage surgery, it is unclear how deep its effects are and whether it causes damage to adjacent tissues. Herein, we report a case of esophageal cancer treated with PDT followed by esophagectomy. In this case, we evaluated the effect of PDT on adjacent tissues based on surgical and pathological examination.Presentation of caseA 58-year-old man with dysphagia was diagnosed with esophageal squamous cell carcinoma (SqCC; T1N0M0, Stage I) in the upper thoracic esophagus. He underwent definitive CRT with two courses of 5-fluorouracil and cisplatin every 4 weeks with 60 Gy of radiation. Twelve months after CRT, endoscopic examination revealed local recurrence, and PDT using talaporfin sodium was performed. The tumor recurred again 6 months after PDT, and robot-assisted thoracoscopic esophagectomy was performed as a definitive treatment. Tissues around the left side of the esophagus and thoracic duct were tightly adherent with severe fibrosis and were successfully removed by extended resection. Histopathological examinations showed that the esophageal wall and peri-esophageal tissue were replaced by fibrous tissue and this extended even beyond the tumor.DiscussionThe primary tumor was limited to the submucosal layer, and the target for irradiation had some longitudinal margins. Therefore, PDT can cause intense inflammation in tissues adjacent to the tumor.ConclusionsIt is necessary to consider the location when performing salvage esophagectomy after PDT.     

Inflammatory myofibroblastic tumor mimicking anterior mediastinal malignancy

Inflammatory myofibroblastic tumor arising in the anterior mediastinum is rare. A 58-year-old woman had an anterior mediastinal mass invading the sternum, pericardium, and pleura. It was completely resected and found to be an inflammatory myofibroblastic tumor. The patient was well and had no recurrence 6 months after surgery.     

Hematoporphyrin derivative and photoradiation therapy in early stage lung cancer

Photoradiation therapy (PRT) with administration of hematoporphyrin derivative (HPD) was performed in ten cases of early stage central-type lung cancer of which six cases were treated by PRT alone due to inoperability because of poor pulmonary function in five and refusal of surgery in one. Four cases were resected after PRT. In the former, complete tumor remission was obtained in all six and in the latter, complete tumor remission was seen in one and significant remission in three. In the nonresected cases four cases are disease-free at 17-41 months and the remaining two cases died of chronic obstructive lung disease and cerebral infarction 16 and 31 months after PRT, respectively. The resected cases are disease-free 7-32 months after surgery. Indications of PRT in early stage lung cancer are discussed according to histological findings of resected specimen.     

Surgery for benign submucosal tumors of the esophagus (leiomyoma and hemangioma)

Among the submucosal tumors of the esophagus, leiomyoma is the most frequently found. Esophageal leiomyoma usually originates from the muscle layer of the esophageal wall and grows spirally around the esophageal axis. In the surgical treatment of leiomyoma, we enucleate the tumor through video-assisted thoracic surgery. When we enucleate leiomyoma, we must be very careful to aviod perforation of the esophageal mucosa. Esophageal hemangioma is a relatively rare disease. The location of this disease is mainly within the submucosal layer, without invading the muscle layer proper. After confirming the localization within the mucosa or submucosa with endoscopic ultrasonography, esophageal hemangioma can be resected safely using the endoscopic mucosal resection technique. In the treatment of benign esophageal submucosal tumors, "informed consent" is as essential as in esophageal cancer surgery. We have no absolute criteria concerning the indications for surgery for benign esophageal submucosal tumors. We must give reasons why the operation is necessary and indicated to the patients. Surgical treatment of esophageal submucosal tumors should be as minimally invasive as possible.     

A case of mucosal esophageal carcinoma with a large intramural metastasis in the stomach

The prognosis of mucosal carcinoma of the esophagus is extremely good because of low frequency of lymphatic invasion compared with submucosal carcinoma. A 64-year-old male was admitted presented with dysphagia and weight loss. Roentgenogram and esophagoscopy revealed erosive lesions in the lower portion of the esophagus and a huge submucosal tumor that looked like the myosarcoma in the cardial portion. After total resection of thoracic esophagus and partial gastrectomy, esophagogastrostomy was done through the anterior thoracic route. During the operation, we found a few disseminative foci in the thoracic cavity (pl1) and direct invasion of cardial tumor to the celiac portion. Therefore, the operation was absolute by palliative. Histological examination of the resected specimen showed that the IIc-like lesion of the lower portion of the esophagus was a moderately differentiated squamous cell carcinoma invading the mucosa (mm), which was 2.0 x 1.6 cm in size, with marked lymphatic invasion, and intra-mural metastatic foci (7.0 x 5.0 cm) at the cardial portion. The patient died 3 months after the operation with mediastinal lymph node metastasis. In our 19 cases of resected mucosal carcinoma of the esophagus, lymphatic invasion was positive in 16%, and lymph node metastasis was positive in 16%, and intramural metastasis was in only one case. Frequency of intramural metastasis in esophageal carcinoma is about 10% in sm -a3 lesion, 5% in mm. In our experience, the prognosis of curatively resected mucosal carcinoma of the esophagus is generally good. We get long survivals, when curative operation is undergone, even if the lymphatic invasion is positive.     

Long-term survival of Askin tumor for 10 years with 2 relapses.

An abnormal shadow was noted on a chest X-ray of a 32-year-old female in a medical check-up in March 1995, 3 months after she had given birth. Thoracic CT detected a tumor in contact with the left thoracic wall, and tumorectomy was performed in May 1995. The tumor was diagnosed as a primitive neuroectodermal tumor (PNET). After surgery, the thoracic wall to which the tumor adhered was treated with irradiation at 50 Gy. Chemotherapy was considered, but the patient did not wish to undergo this treatment. Lung metastasis occurred 5 years after the first surgery, and the left lower lobe of the lung was partially resected. Four years later, lobectomy of the left lower lobe of the lung was performed, due to further lung metastasis. The patient remains healthy as of April 2005.     

En Bloc Resection with the Assistance of Video‐Assisted Thoracoscopy for Left Lower Lung Cancer Invading Thoracic Vertebrae and Rib: A Case Report

Lung cancer invading the spine was previously considered unresectable and fatal and, consequently, there are few reports focusing on tumors located in the lower lung lobe and invading the spine. With the development of spinal instrumentation and surgical techniques, and wider acceptance of spondylectomy by surgeons, radical surgical resection has become feasible. Here, we present a case of a male patient with a left lower lung cancer invading thoracic vertebrae who underwent complete resection with sagittal en bloc hemivertebrectomy with video‐assisted thoracoscopy. A 60‐year‐old man complained of left chest pain for 3 months. Chest computed tomography and thoracic vertebrae magnetic resonance image revealed that a tumor in the left lower lung lobe had invaded the seventh and eighth thoracic vertebrae and the eighth rib. As no lymph node or distant metastasis was detected by positron emission tomography‐computed tomography, the patient was diagnosed with left lower lung cancer directly invading the seventh and eighth thoracic vertebrae and the eighth rib (T4N0M0, stage IIIA) instead of metastasizing to the thoracic vertebrae. An en bloc resection of the lung tumor and the involved vertebrae was performed by a thoracic surgeon and orthopaedic surgeon with video‐assisted thoracoscopy. Six months after the operation, there was no evidence of local recurrence, and the patient had recovered well. En Bloc resection with video‐assisted thoracoscopy for lung cancer invading thoracic vertebrae is a safe and feasible surgical method. This method can significantly improve the safety and convenience of this type of surgery.     

Removal of renal cell carcinoma extending into the right atrium: report of a case]

A 65-year old man presented with a seven-month history of macrohematuria and left back pain. Abdominal ultrasonography, enhanced computed tomographic (CT) scanning, magnetic resonance imaging (MRI), selective renal angiography and vena cavography revealed a left renal tumor extending into the inferior vena cava and right atrium. Surgery was performed using the cardiopulmonary bypass and the whole tumor was resected grossly except for the tumor invading into the lumbar vein. The patient recovered promptly but died from cancer metastasis six months after operation.     

Granular cell tumors of the esophagus. Apropos of a case combined with an epidermoid carcinoma of the esophagus

A 51-year-old man had epidermoid carcinoma in the middle third of the esophagus. The esophagus was resected. On histologic examination there was a granular cell tumor in the lower third of the esophagus. The patient died 4 months after surgery from pulmonary failure. Granular cell tumors are generally benign. There have been 86 cases involving the esophagus discussed in the literature; 7 cases were associated with bronchial [3], esophageal [2], gastric [1] or otolaryngeal [1] carcinoma and 1 with a lymphoma. Our case emphasizes the need to evaluate the entire esophagus when a lesion is identified. The occurrence of granular cell tumor of the esophagus justifies prolonged surveillance in order not to neglect an associated tumor.     

Primary malignant melanoma of the esophagus —A case report—

An unusual case of primary esophageal melanoma is reported herein. A 68 year old man who had experienced occasional dysphagia for about one month without suffering any weight loss was admitted to our department. An esophagogram revealed two lobulated masses and esophagoscopy showed a pigmented tumor in one of the masses. Curative surgery was thus performed through a right thoracotomy. The macroscopic appearance of the resected specimen was very unusual and it was subsequently proven to be primary malignant melanoma of the esophagus by histological examination. Postoperatively, cyclophosphamide and interleukin-2 were administered intravenously, followed by lymphokine-activated killer therapy. However, multiple liver metastases were found on a CT scan, 3 months after the operation and the died about 1 month later. The operative indications for primary malignant melanoma of the esophagus are discussed in this report.     

Primary leiomyosarcoma of the anterior mediastinum encasing the aortic arch, left common carotid and left subclavian arteries

A 66-year-old man presented with a one month history of hoarseness. Left recurrent nerve palsy and a left upper mediastinal mass were observed by an otorhinolaryngologist who referred the patient to our department. Chest computed tomography showed a superior mediastinal mass, which seemed to involve the left common carotid and left subclavian arteries from the greater curvature of the aortic arch. The innominate vein was compressed, and collateral circulation was well developed. The left upper lobe of the lung was also seemed involved. A mediastinal biopsy conducted via left thoracoscopy revealed a malignant spindle cell tumor. The mediastinum was irradiated (40 Gy), and surgical extirpation was subsequently undertaken 3 weeks later. The tumor was successfully removed without the use of extracorporeal circulation. Because only smooth muscle actin was focally but strongly expressed immunohistochemically, leiomyosarcoma was confirmed. The patient was discharged on day 14. A solitary left pleural metastasis was observed and resected 12 months after the surgery and the patient is well without further recurrence 16 months after the initial surgery.     

Primary malignant melanoma of the esophagus--a case report

An unusual case of primary esophageal melanoma is reported herein. A 68 year old man who had experienced occasional dysphagia for about one month without suffering any weight loss was admitted to our department. An esophagogram revealed two lobulated masses and esophagoscopy showed a pigmented tumor in one of the masses. Curative surgery was thus performed through a right thoracotomy. The macroscopic appearance of the resected specimen was very unusual and it was subsequently proven to be primary malignant melanoma of the esophagus by histological examination. Postoperatively, cyclophosphamide and interleukin-2 were administered intravenously, followed by lymphokine-activated killer therapy. However, multiple liver metastases were found on a CT scan, 3 months after the operation and he died about 1 month later. The operative indications for primary malignant melanoma of the esophagus are discussed in this report.     

Cystic adenoid cancer of the esophagus. Report of a case and review of the literature

A 59-year-old man had adenoid cystic carcinoma of the esophagus. The tumor, in the lower third of the esophagus, was resected; the patient died 7 months after surgery from widespread distant metastases. The initial diagnostic was epidermoid carcinoma on the biopsy. In the literature adenoid cystic carcinoma are frequently associated with epithelial abnormalities. Also of interest within the literature was the fact that radiotherapy and combination chemotherapy may be an effective treatment modality for this cancer.