A case of typical carcinoid accompanied with left atrium myxoma

A 78-year-old female was admitted to Shizuoka red cross hospital because of an abnormal shadow at the right upper lung field on chest X-ray film. A left atrium myxoma was detected at chest CT scan after admission. Though the lung tumor was well defined and hilar and mediastinal lymph nodes were not swollen at CT scan, the tumor was suspected a small cell carcinoma at the result of trans-bronchoscopic biopsy. Firstly we performed removal of the left atrium myxoma, and two months later, we performed thoracotomy and partial resection of the right upper lobe. The lung tumor was finally diagnosed as a typical carcinoid. We have followed the patient for about 32 months after the operation and there is no evidence of tumor recurrence.     

Recurrent thymic carcinoid tumor--report of a case

A previously operated 62-year-old male with recurrent thymic carcinoid tumor was reported. This patient underwent resection of the thymic carcinoid tumor through left thoracotomy 7 years ago. Although the postoperative clinical course was uneventful, an anterior mediastinal tumor on the patient's chest was discovered after an X-ray examination due to a traffic accident in July, 1989. With the diagnosis of recurrent thymic carcinoid tumor, he underwent an excision of the anterior mediastinal tumor and residual thymus. He also underwent partial resection of the pericardium, mediastinal pleura, and left upper lobe of the lung. 42 cases with thymic carcinoid tumor that have been reported in the Japanese literature were reviewed. A perusal in the relevant literature suggested that total thymectomy was advisable because partial thymectomy was associated with a high risk of local recurrence and metastases.     

Primitive chest wall neuroectodermal tumor in a pediatric patient

A 13-year-old boy with a primitive neuroectodermal tumor of the chest wall is presented. After four cycles of chemotherapy, a computed tomography scan of his chest showed a larger mass invading the left upper lobe of the lung. He underwent resection of the left chest wall from the left fourth to sixth ribs, including the tumor, combined with left upper lobectomy and lymph node dissection. A diagnosis of primitive neuroectodermal tumor was confirmed histopathologically and immunohistochemically. After surgery, four cycles of chemotherapy with ifosfamide and etoposide were given. One year after treatment, the patient is currently doing well without evidence of recurrence.     

A case of thymic carcinoid

Thymic carcinoid is rare disease. The frequency, treatment and prognosis of thymic carcinoid are discussed. This report presents a case of a 55-year-old man who underwent rt-hemithymectomy and radiotherapy postoperatively. The patient had no complaint but chest roentgenogram and CT scan revealed an abnormal mass in the anterior superior mediastinal region. Through median sternotomy, rt-hemithymectomy including partial resection of the pericardium was performed. The tumor was 6 X 5 X 5 cm in size, and diagnosis of thymic carcinoid was histologically established. The patient was discharged after postoperative irradiation of total dosage of 54 Gy to the mediastinum. He was no evidence of recurrence twelve months after operation.     

Chest wall implantation of thymic cancer after computed tomography-guided core needle biopsy.

Percutaneous core needle biopsy is a useful procedure for diagnosing lung and mediastinal tumors. However, it has the potential to spread malignant cells from the tumor to the chest wall and pleural cavity. We report the case of a patient with thymic cancer who developed a metastatic tumor at the transthoracic needle biopsy site following a curative resection. The patient underwent an additional chest wall resection, but she developed recurrence in the pleural cavity 1 month after the second operation. The risk of tumor implantation and the related complications that can occur with transthoracic needle biopsy should be considered in patients with a malignant tumor. The indications for transthoracic needle biopsy should be restricted.     

Malignant fibrous histiocytoma of the diaphragm — a case report —

A 56-year-old woman was admitted to our hospital with the chief complaint of left back pain. We detected left pleural effusion on chest X-ray and performed chest drainage. No malignant cells were detected in the effusion. Chest CT demonstrated a tumor shadow over the left diaphragm and left pleural effusion 6 months later. She underwent en bloc resection of the tumor and left diaphragm. Histological evaluation revealed malignant fibrous histiocytoma (MFH). Recurrent tumors were found in the abdomen 8 months after the operation, and she underwent resection of the abdominal recurrent tumors. Histological evaluation of the recurrent tumors also showed MFH. The patient died 28 months after the first operation.     

Primary testicular carcinoid tumor with teratoma: a case report

We report a case of primary testicular carcinoid with teratoma and review the literature. A 68-year-old man was hospitalized with an asymptomatic left testicular mass. Left radical orchiectomy was performed under a diagnosis of testicular tumor. Histologically, the tumor showed a typical appearance of teratoma with carcinoid components. Barium studies, computed tomographic scan could not demonstrate any other tumor anywhere else. He is now being followed at our clinic without any evidence of recurrence.     

Mediastinal mature teratoma with rupture into pleural cavity due to blunt trauma

We report a rare case of mediastinal mature teratoma with rupture due to blunt trauma. A 15-year-old boy had received a strong head-butt in the left upper chest wall and was admitted with the sudden onset of left-sided severe chest pain and dyspnea. Chest computed tomography (CT) scan on admission revealed a heterogeneous mass lesion in the anterior mediastinum. The contrast-enhanced CT scans obtained 2 days after admission showed not only mediastinal mass lesion but also left pleural effusion. On the radiologic finding at 5 months later, the lesion became larger and was thought to be a typical mediastinal mature teratoma. The patient underwent extirpation of the tumor. Microscopically, the tumor was typically composed of adult-type tissues and was confirmed to be mature teratoma.     

Atypical carcinoid of thymus associated with multiple endocrine neoplasia syndrome type 1

Thymic carcinoid associated with multiple endocrine neoplasia syndrome type 1 (MEN-1) is a rare tumor. We report a case of MEN-1-related thymic carcinoid. The patient reported herein had already been diagnosed with MEN-1 and was found to have a mediastinal mass. She underwent thymectomy with partial resection of the left innominate vein and lung. Histological examination revealed atypical carcinoid with infiltration. MEN-1 gene mutation was detected by employing the direct nucleotide sequencing method. Postoperative 2-fluoro-2-deoxyglucose positron emission tomography showed probable multiple metastases in the vertebrae and myocardium. However, she has been alive and asymptomatic for 2 years postoperatively. MEN-1-related thymic carcinoid is often insidious with a poor prognosis. We suggest chest computed tomography scan or magnetic resonance imaging for MEN-1 patients and serological or genetic screening for patients with thymic carcinoid to screen for MEN-1.     

A case report of widely recurrent carcinoid tumor of the thymus

We performed wide resection of recurrent carcinoid tumor of thymus. A 62-year-old male patient admitted to our department because of swelling of anterior chest wall. He had received extirpation of thymic carcinoid tumor 5 years ago and he was pointed out large mass formation in anterior mediastinum before admission. Wide resection of tumor including pericardium, chest wall, left lung and left brachiocephalic vein was performed. Left brachiocephalic vein was reconstructed and pericardium was replaced with Gore-Tex patch. The carcinoid tumor of thymus sometimes invade to adjacent organs and is apt to recur long time after first operation.     

Pleural metastasis of atypical meningioma: a novel therapeutic approach

Meningiomas are the most common intracranial tumours in adults and they are infrequently associated with a metastasis clinical course. Pleural metastases are extremely rare and no guidelines on a specific treatment have been established. When localized, surgical resection is the mainstay of treatment, but there is a high risk of pleural recurrence. We aimed to describe a novel surgical approach in pleural metastasis of meningiomas. We report the case of a 41-year-old man with the medical history of surgically resected intracranial atypical meningioma. Nine years after diagnosis of atypical meningioma, a CT scan of the chest disclosed 10 pleural implants gathered in the fissure, in the paramediastinal pleura and at the base of the left hemithorax. Surgical resection was decided. Parietal and mediastinal pleura resection with visceral pleural lesions removal were performed. Cytoreductive surgery was associated with intrathoracic hyperthermic chemotherapy. Postoperative course was uneventful and no adjuvant therapy was undertaken. The patient is free of pleural recurrence 12 months post operatively. The present case report suggests that cytoreductive surgery with intrathoracic hyperthermic chemotherapy is feasible and safe in pleural metastasis from meningioma. Prolonged follow-up and prospective studies are mandatory to assess its oncological benefit.     

Metachronous bronchial carcinoid tumor.

We report a rare case of bilateral metachronous bronchial typical carcinoid tumor surgically treated. At the age of 33 years, the patient underwent, in another hospital, a left upper lobectomy for a typical carcinoid tumor. After 4 years, the patient manifested the symptoms of a new central typical carcinoid tumor located at the origin of the middle lobe bronchus and infiltrating the intermedius one. This tumor was first treated by laser therapy, but long-term follow-up evaluation with bronchoscopy revealed a local recurrence of disease. So we performed a middle sleeve lobectomy with radical node dissection.     

Resection of malignant fibrous histiocytoma through a combined thoracic and abdominal wall approach

We report a case of resection of malignant fibrous histiocytoma (MFH) via combined thoracic and abdominal wall incision reconstructed using GORE DUALMESH. A 60-year-old woman underwent resection of a left lower chest wall tumor. Since the tumor infiltrated into the diaphragm, a part of the left diaphragm and left upper abdominal wall were resected together. The left chest was closed by suturing the diaphragm to the ribs. The resected area of the thoracic and abdominal wall was 12×12 cm and was reconstructed with GORE DUALMESH. She received adjuvant radiotherapy as the tumor cells were detected in the surgical margin of the diaphragm. The patient has remained well without signs of recurrence for 10 months after the operation.     

Bronchoplasty for bronchial carcinoid tumor without removing lung parenchyma

A 15-year-old boy was admitted with a pneumothorax of the left lung. Computed tomographic scans demonstrated a tumor 20 mm in diameter situated on the left main to upper lobar bronchus that eventually was proved to be a typical carcinoid tumor by transbronchial biopsy. We performed bronchial resection with atypical bronchoplasty, which preserves lung parenchyma in cases of s-T1N0M0 disease. The patient has had no evidence of recurrence 7 years after surgery.     

Lung metastasis of malignant peripheral nerve sheath tumor: report of a case

A 37-year-old man with von Recklinghausen's disease admitted to our hospital because of chest abnormal shadow. He had underwent extended radical tumorectomy for malignant peripheral nerve sheath tumor (MPNST) in left lower limb 33 months before. Chest X-ray and computed tomography (CT) scan revealed solitary tumor on right S10. Tumor was resected under thoracoscopic surgery. Histological diagnosis was metastasis of MPNST. MPNST with lung metastasis showing very poor prognosis. The patient is doing well 2 years after pulmonary resection without recurrence. Careful follow up is important for MPNST.     

Recurrent thymic carcinoid tumor in the pleural cavity

Thymic carcinoid is a rare malignant tumor having a high incidence of local recurrence and distant metastasis. To date, few reports have described the reoperative management of recurrent thymic carcinoid appearing as a pleural tumor. Here we report 2 such cases in long-term survivors. Long-term follow-up is recommended for patients with thymic carcinoid even after curative surgery. Aggressive treatment including surgical resection may prolong survival in these patients.     

Pulmonary typical carcinoid tumor and liver metastasis with hypermetabolism on 18-fluorodeoxyglucose PET: a case report.

Pulmonary carcinoid tumors are generally hypometabolic on 18-fluorodeoxyglucose (FDG)-positron emission tomography (PET). We experienced a case of pulmonary typical carcinoid that showed rapid growth and high FDG uptake at the primary site and liver metastasis. A 56-year-old man with hemosputum had a medical examination by his family physician. A roentgenogram and computed tomography of the chest showed a solitary solid mass on the right lower lung field. However, he had not been shown an abnormal shadow on a roentgenogram taken 8 months earlier. He had undergone fiber-optic bronchoscopy, but the cytological diagnosis showed no evidence of malignancy. After that, FDG-PET was examined and revealed hot spots in the pulmonary tumor and liver mass. A standard uptake value of this pulmonary tumor was 32.9 mg/mL, and that of the liver mass was almost the same value of pulmonary lesion. He had undergone a right lower lobectomy diagnosed as a typical carcinoid. Thereafter he underwent partial resection of he liver mass, and the histology was metastasis from pulmonary carcinoid. We first reported a typical pulmonary carcinoid that showed high FDG uptake at the primary site and liver metastasis.     

Chest wall metastasis from recurrent meningioma

Meningiomas are generally considered benign lesions. A minority, however, are capable of metastasis. The ones most likely to do so are commonly recurrent or frankly malignant in nature. The optimal management of such metastases is unclear. This is the first reported case of meningioma presenting as an isolated metastasis to the chest wall. This case involves a 64-year-old woman without significant medical or family history who underwent resection of a meningioma of the right cerebral hemisphere. She was treated 10 years later for recurrence by stereotactic radiosurgery. Three years after that, the patient's family noticed a mass on the left chest wall. A CT scan revealed destruction of the ninth rib laterally and subpleural extension. The patient subsequently underwent resection of full-thickness chest wall for a presumed soft-tissue sarcoma. Further pathologic evaluation including electron microscopy and immunohistochemistry revealed metastatic meningioma. The patient received adjuvant radiation to the chest wall and is currently free of disease at the chest wall one year after surgery. This case illustrates the difficulty in establishing an accurate diagnosis of metastatic meningioma. Consequently in selected patients with a history of the disease the diagnosis of metastatic meningioma must at least be considered. Resection of an isolated metastasis in this setting appears warranted.     

Mucoepidermoid carcinoma of the thymus treated by multimodality therapy: a case report.

A case report of mucoepidermoid carcinoma of the thymus, aggressively treated by multimodality therapy including surgery, radiotherapy, chemothermotherapy, and systemic chemotherapy is presented. The patient, a 53-year-old man, underwent potentially complete resection for an anterior mediastinal tumor, histologically diagnosed as a mucoepidermoid carcinoma of the thymus with Masaoka stage II disease. However, because of local recurrences in the left chest wall and pleura, re-resection was twice performed 4 years and 5 months, and 5 years and 7 months after the initial surgery, in combination with intrathoracic chemothermotherapy and irradiation. Seven years and 1 month after the initial operation, in vitro chemosensitive test based-chemotherapy using vinorelbine for pleural disease was performed, resulting in maintenance of good quality of life (QOL) due to dramatic decrease in pleural effusion. He died of tumor progression, 7 years and 9 months after the initial treatment. Although the clinical aspects of thymic mucoepidermoid carcinoma are little known, it is assumed that such aggressive therapeutic multimodalities as repeated surgical resection, irradiation and chemothermotherapy, and chemotherapy based on in vitro chemosensitivity tests contributed to long-term survival for this unusual disease.