Mucinous adenocarcinoma of the anterior mediastinum

The authors report are a rare case of primary mucinous adenocarcinoma of the anterior mediastinum in a 34-year-old Japanese woman. Routine chest radiography revealed an abnormal mass lesion in the left upper mediastinum. Her serum CA 19-9 level was elevated at 299 (normal < 37) U/ml. The large tumor in the anterior mediastinum, 8 cm in diameter, were made of multicystic part with thick wall and thick spetrum and solid part in chest computed tomography (CT). Teratoma was suggested by percutaneous needle biopsy under CT scanning. When the chest was opened through a median sternotomy, adding a left collar incision, we found a hard tumor occupying the superior anterior mediastinum and then resected the tumor together with the left brachiocephalic vein, the left pleura, the pericardium and the left phrenic nerve because of invaded them. Grossly, the tumor was 13 x 10 x 8 cm and weighted 400 g. Pathologic diagnosis was mucinous adenocarcinoma of the anterior mediastinum. No primary cancer lesions were found in pancreas, ovarium, gastrointestinal tract and mammary gland. Microscopic examination showed minimal atypia site in mucinous adenocarcinoma and normal thymic tissues surrounding this tumor. These findings have led this case to conclude the primary tumor of thymus.     

Complete resection of thymic carcinoma supported by cardiopulmonary bypass

We would like to report on a case of thymic carcinoma that could be completely resected supported by extracorporeal circulation. A 53-year-old female complaining of severe coughing and hoarseness was admitted to our hospital. Her chest X-ray film revealed an abnormal shadow in the upper mediastinum and an elevation of the left diaphragm. Chest CT and MRI showed an anterior mediastinal mass that invaded the main pulmonary artery. The preoperative histological diagnosis of thymoma was made by mediastinoscopic specimen. After 50 Gy irradiation, surgery was performed. During the operation, after resection of the left brachiocephalic vein and a part of the upper lobe of the left lung, the tumor was detached from the wall of the aorta and resected with the invaded part of the pulmonary artery supported by cardiopulmonary bypass. Reconstruction of the pulmonary wall defect was accomplished with Xenomedica. The final pathological diagnosis was thymic adenosquamous carcinoma. The postoperative course has been uneventful 24 months after surgery. Extracorporeal circulation is a useful technique in operations involving malignant diseases when complete resection is able to be accomplished.     

Multiple glomus tumors in chest wall and buttocks

We report a case of a 50-year-old man with multiple glomus tumors of the chest wall and buttocks. He was admitted to our hospital because of right chest pain for 10 years. The chest pain was lancinating and gradually increasing. A computed tomography (CT) showed a mass in the right 3rd intercostal space and a mass in the right buttocks. The chest tumor was enhanced with contrast medium on chest CT. Two tumors were resected completely including the 4th rib. Histological examination showed numerous vascular space lined with sheets of epithelial cells (glomus cells), so they were diagnosed as glomus tumor. The postoperative course was well, and the pain disappeared after resection. The glomus tumor of chest wall could be diagnosed as malignant tumor, based on the criteria of the size more than 2 cm and deep location. The glomus tumors which occurred in the chest wall and buttocks were very rare. We presented the case with reference to the literature.     

Curative surgery for locally advanced retroperitoneal mature teratoma in an adult. Case report

INTRODUCTIONPrimary teratomas of retroperitoneum are not usual in the adult population. These tumors most commonly seen at the gonadal and sacrococcygeal regions. Herein we describe a case of an 18-year-old female who had a benign cystic teratoma at the retroperitoneum.PRESENTATION OF CASEThe patient underwent an operation at another hospital following a misdiagnosis of hydatid cyst. The patient was referred to our hospital because of the detection of an unresectable tumor during her operation. A computerized tomography (CT)–angiography revealed a cystic mass, with a diameter of 14 cm which was invaded into the retrohepatic suprarenal inferior vena cava and also extended to the posterior aspect of the liver. Additionally the mass invaded the posterior wall of the inferior vena cava and the right renal vein. The tumor was completely resected with a vascular resection. The inferior vena cava was reconstructed with a 12 cm Dacron^® graft and the renal vein was implanted. The patient's postoperative period was uneventful.DISCUSSIONGerm cell tumors of retroperitoneum are usually seen in children, but there are also some reports of adult cases in the literature. Adult cases are especially seen in females. Imaging studies are paramount for diagnosis, preoperative strategy and safe surgical excision. CT scans and MRIs can identify various components of these tumors.CONCLUSIONEven though primary retroperitoneal teratomas are quite rare in adults. Preoperative radiology imaging and strategy is critical for performing a safe surgery. The gold standard treatment strategy for this neoplasm is the surgical resection.     

Anterior sacral meningocele. Case report

A 53-year-old male presented with an abdominal mass and urinary disturbance. Plain pelvic X-rays revealed a scimitar deformity of the sacrum. Computed tomography (CT) of the abdomen and lumbosacral spine showed a 13 X 17 X 17 cm, hypodense, cystic mass. Metrizamide myelography disclosed a bony defect at the S2 level through which contrast material entered the pelvic cyst, confirming the diagnosis of anterior sacral meningocele. Magnetic resonance imaging demonstrated the extent of the abdominal mass and its communication with the thecal sac through the anterior sacral defect. The patient underwent surgery via the transabdominal approach. The mass was extremely adherent to the intestine and it was difficult to reach the stalk of the sac. The wall of the meningocele was resected to the extent possible, and was tightly sutured following a meningocele-peritoneal shunting procedure. Postoperatively, the patient was neurologically normal, but 4 months later he was readmitted because of headaches and clouding consciousness. CT showed bilateral chronic subdural hematomas. Following their evacuation, the patient recovered uneventfully. The clinical and neuroradiological features and the surgical approaches to anterior sacral meningoceles are discussed.     

A case of invasive thymoma displaying endobronchial and endocaval polypoid growth

The hens' egg-sized tumor connecting from anterior mediastinum to the hilus by chest radiography and chest CT was noted in a 63 year old female who complained of facial swelling and cough. The defect of the thumb tip-sized shadow was noted in the superior vena cava by superior vena cavography, and polyp covered with white coating obstructing the right apical bronchus was noted by fibrotic bronchoscopy, and malignant finding was obtained by biopsy of this polyp. After midsternotomy, a mass invaded to the superior vena cava and the right upper lobe was resected, and then superior vena cava was reconstructed by using supported polytetrafluoroethylene. The resected specimen revealed that the tumor extended not only to the pulmonary parenchyma with polypoid growth into the lumina of bronchi but also to the superior vena cava with polypoid growth. The patient was discharged at the postoperative radiotherapy with 40 Gy, and he is still alive free from the disease 3 years and 11 months after operation.     

Scapular osteochondroma with reactive bursitis presenting as a chest wall tumour.

A 32-year-old male presented with a painful, rapidly enlarging chest wall mass. A malignant chest wall neoplasm was suspected. A CT scan was performed which showed a mass extending from under the scapular and an exostosis arising from the anterior surface of the scapular. The mass and exostosis were resected resulting in complete resolution of symptoms. Histological examination showed the mass to be a reactive bursa, with no evidence of neoplasia.     

Gastrointestinal Stromal Tumor of the Rectum Resected by Laparoscopic Surgery: Report of a Case

A 53-year-old man visited our hospital with the chief complaint of pain on urination. On digital rectal examination, a rigid immobile tumor mass with a smooth surface was palpated on the anterior wall on the right side of the rectum near the anal canal. Computed tomography (CT) and magnetic resonance imaging (MRI) of the pelvis revealed a heterogeneous tumor mass measuring 6.5 cm in diameter, which occupied the cavity of the lesser pelvis. This rectal tumor was diagnosed to be a gastrointestinal stromal tumor (GIST) based on the results of a transrectal needle biopsy. A laparoscopic abdominoperineal resection of the rectum was performed to remove the mass. The intraoperative findings showed an ambiguous boundary between the tumor and the rectum but clear boundaries between the tumor and the peripheral organs, and the use of a laparoscope allowed for a good separation by providing a good visual field. The bleeding volume was approximately 80 ml and the operative time was 320 min. The macroscopic findings of excised specimens of the mass showed the tumor, measuring 6.5 × 5.5 × 5.0 cm, to be growing extrinsically from the anterior wall on the right side of the rectum. A histological examination of the excised specimens revealed at most 5 mitoses per 50 high-power fields (×400). The tumor mass was diagnosed to be a GIST of low-grade malignancy based on these findings. The postoperative course was favorable, and there were no postoperative complications. The patient was discharged on the 8th hospital day. Laparoscopic surgery is a minimally invasive surgical procedure for rectal GIST, which is excellent in terms of esthetics. Laparoscopic surgery is therefore considered to be useful for a resection of the rectum, because the magnifying effect allows surgical maneuvers with a favorable visual field within the pelvis.     

Coexistence of cyst and tumor in the same kidney: a case report

A case of renal cyst associated with renal tumor is presented herein. A 40-year-old male patient visited our outpatient clinic for left renal cyst which had been found by ultrasonography on routine clinical examination. CT scan demonstrated an irregular area in the cyst wall measuring about 2 cm in thickness which showed enhancement of density with contrast medium. Magnetic resonance imaging (MRI) also demonstrated a round mass with abnormal signal on the cyst wall, protruding into the cyst cavity. Transabdominal radical nephrectomy was performed on 13 July 1987, and to the resected kidney was attached a cyst measuring 7 cm in diameter in the lower pole. Grossly, the cyst contained amorphous red-brown material which turned out to be old blood clots and the wall harbored a tumor (3.0 x 2.5 cm). Histologically, the tumor was renal cell carcinoma, the surface of which was covered with necrotic tissue. The coexistence of renal cyst and tumor is rare and 62 cases were collected from the Japanese literature including our case, and discussion was made in relation to the etiological factors.     

A case of gastrointestinal stromal tumor of rectum, difficult to differentiate from leiomyosarcoma of prostate

A 70 year-old male was seen at the hospital with the chief complaints of frequent miction and incomplete urinary retention. A hen's egg-sized firm mass was palpable in anterior wall of rectum by digital rectal examination. Intravenous urography showed severe bilateral hydronephroureter. Transrectal ultrasound, CT scan and MRI revealed a mass with 5 cm in diameter between prostate and rectum, and the margin of them were unclear. On needle biopsy of the tumor, leiomyosarcoma of the prostate was suspected. We performed radical cytectomy and created continent urinary reserver. Because the tumor and rectum could not be lysed, part of the rectum was resected. Histological examination showed gastrointestinal stromal tumor (GIST) of rectum. GIST of rectum is a rare entity, and in case of contact with the prostate, it is difficult to differentiate from leiomyosarcoma of prostate.     

Metastatic small intestinal tumor associated with transitional cell carcinoma: a report of 2 cases and review of cases in Japan

Transitional cell carcinoma (TCC) frequently metastasizes to lymph nodes, liver, lungs and bone. However, metastasis to the gastrointestinal tract is rare. We report two cases of bladder tumor which metastasized to the ileum. According to the literature, these are the 7th and 8th cases in Japan. Case 1: A 87-year-old man had a history of bladder tumor (TCC, grade 3, pT2bN0M0) and has transurethral resection of bladder tumor (TUR-BT) three times. Two months after the last TUR-BT, he was admitted with ileus. As computed tomography (CT) showed abdominal free air, our diagnosis was perforation of gastrointestinal tract. The patient received an operation which resected partial ileum. We found the elastic hard tumor in the ileum on the perforated lesion, which showed metastatic TCC in the ileum pathologicaly. Case 2 : A 53-year-old man visited our hospital with gross hematuria. Cystoscopy showed a non-papillary broad based tumor in the right wall of the bladder. CT showed a bladder tumor invaded into the prostate (pT4aN1M0), we performed total cyctectomy and ileal conduit after neo-adjuvant chemotherapy. During the operation, we found the tumor (2 cm in diameter) in the small intestine which was metastasized of bladder tumor.     

Clear cell adenocarcinoma with acomponent of well-differentiated fetal adenocareinoma; report of a case

A 69-year-old woman complaining of a cough was admitted to our hospital. Chest X-ray showed a mass in the right lower lung field. Chest computed tomography (CT) showed a tumor with notch, 3 cm in diameter, in the right lower lobe (S9-S10). The tumor was diagnosed as adenocarcinoma by the biopsy under chest CT. The patient underwent right lower lobectomy (ND2a). The tumor was whitish solid mass, 35 x 34 x 29 mm in size. Histopathologically, the tumor was diagnosed as clear cell adenocarcinoma with a component of well-differentiated fetal adenocarcinoma (WDFA), pT2N0M0, stage IB. The patient was discharged and received postoperative chemotherapy (UFT). The patient has been doing well without any tumor recurrence for 1 year postoperatively.     

Thymic basaloid carcinoma

We report a case of thymic basaloid carcinoma combined with multilocular thymic cyst (MTC). A 72-year-old man was found to have an abnormal shadow on a chest X-ray without pny symptoms. Chest computed tomography (CT) showed a smooth edged anterior mediastinum tumor projecting to the left lung field. After preoperative chemotherapy by irinotecan hydrochloride (CPT-11) and radiotherapy of 40 Gy, chest CT showed a large part of the tumor projecting to the left lung field had changed to a cyst. After the pericardium and upper lobe of the left lung to which the MTC adhered was partially resected via left thoracotomy, the tumor was resected with innominate vein via median sternotomy. The operation was followed by CPT-11 chemotherapy and radiotherapy of 20 Gy. The tumor was thymic basaloid carcinoma 3 x 2.5 x 2 cm in size combined with MTC 8.2 cm maximum in diameter. As he died of another disease 6 months after excision, sufficient postoperative observation was not obtained. Thymic basaloid carcinoma is rare and only 14 cases including the present case have been reported.     

Solitary fibrous tumor of the thymus with local invasiveness and pleural dissemination: report of a case.

A 74-year-old asymptomatic female presented with an anterior mediastinal mass incidentally discovered on a routine chest X-ray. Systemic evaluation demonstrated no metastatic lesions. The patient underwent an extended thymectomy via median sternotomy on suspicion of a thymoma. The tumor had arisen from the left half of the thymus without a pedicle and had directly invaded into the left lung and pericardium. The tumor was resected with the entire thymic tissue, and the invaded lung and pericardium were resected en-bloc. The size of the tumor was 5.3x4.0 cm. A disseminated lesion on the mediastinal pleura was also resected. Histopathologically, the lesion mainly consisted of non-atypical spindle-shaped tumor cells in a so-called "patternless pattern" with various densities of collagenous background. Pleomorphism and mitoses were not significant. Immunohistochemical analysis revealed mesenchymal positive markers such as vimentin and CD34. Epithelial markers such as CAM 5.2 and AE1/AE3 were negative. S-100 protein and desmin were not stained. Solitary fibrous tumor of the thymus was diagnosed histologically. Postoperative adjuvant chemotherapy or radiotherapy was not undertaken because the benefits were uncertain. She is well without recurrence 3 months after the operation.     

Urothelial carcinoma of ureter with neuroendocrine differentiation: a case report

A 73-year-old woman complained of gross hematuria. Urine cytology showed small cell carcinoma (SmCC) cells mixed with urothelial carcinoma (UC) cells. Cystoscopy revealed a bladder tumor around the right ureteral orifice. Abdominal CT demonstrated severe right hydronephrosis. Pelvic MRI showed a mass (approximately phi5 cm) in the urinary bladder wall that protruded into the lumen. TUR biopsy of the bladder tumor was SmCC. With laparoscopic nephrectomy/open ureterectomy, distal end (approximately 10 cm) of the right ureter was tumorous and obstructed. The tumor invaded into the urinary bladder/peritoneum and was unresectable. The tumor of lower-end of ureter tumor was SmCC, showing neuroendocrine differentiation such as pseudo-rosette, positive Grimelius stain, and chromogranin A/NCAM/synaptophysin immunostaining. Proximal to this tumor, non-invasive UC spread superficially over entire length of the ureter to the renal pelvis. Abrupt transition from invasive SmCC to non-invasive UC was observed in the middle of the ureter. Post-operative adjuvant chemotherapy was discouraged due to senile dementia of the patient. The patient died nine months after the operation because of systemic progression of cancer.     

Mediastinal cystic lymphangioma; report of a case

A cystic lymphangioma is a rare mediastinal benign tumor. A 38-year-old male was referred to our hospital because of an mediastinal mass incidentally detected on chest X-ray. The mass had enlarged rapidly during the course of 1 year. Computed tomography (CT) of the chest showed a 7 cm well defined cystic tumor in the left anterior mediastinum. Magnetic resonance imaging (MRI) demonstrated a mass with heterogeneous high signal intensity on enhanced T2-weighted images. The cystic tumor, localized in the mediastinal adipose tissue, was completely resected by a thoracoscopic procedure. A pathological examination confirmed the diagnosis of a cystic lymphangioma.     

A case of mediastinal cavernous hemangioma

A 6-year-old boy had an abnormal shadow on the chest X-ray film. It showed a tumor shadow with calcification on the right hilum. The plain CT scan showed an anterior mediastinal mass and its density was similar to that of large vessels. On the angio CT scan the lesion displayed a much lower enhancement than large vessels. The tumor was resected completely by median sternotomy. It was 5.6 X 3.6 X 3.0 cm in size and contained a phlebolith 5 mm in diameter. The histological diagnosis was cavernous hemangioma.     

Inflammatory type of malignant fibrous histiocytoma in the anterior mediastinum--a case report]

A 58-year-old female was admitted to our hospital with a complaint of anterior chest tumor, fever of unknown origin and anemia. Chest X-ray films and chest CT scans revealed a large tumor in the anterior mediastinum, there were strong inflammatory reactions in laboratory studies. The tumor was resected with a part of the rt anterior chest wall. The partial resection of the upper and middle lobe of the rt lung and the pericardium which were invaded of the tumor were performed. Postoperative course was uneventful and body temperature went down. Inflammatory reaction and anemia got also improved. In histological findings, both rounded histiocyte-like and spindled fibroblast-like tumor cells were arranged in a random or haphazard fashion and showed a storiform pattern. And there was a collection of xanthoma-like foamy cells and invasive inflammatory cells. So the histological diagnosis was inflammatory type of MFH. As far as we investigated, this case was the 23rd mediastinal MFH in the world literature.     

A resected case of malignant fibrous histiocytoma of the chest wall

We report a 74-year-old woman with malignant fibrous histiocytoma (MFH), treated successfully by radiation and followed with chest wall resection and reconstruction. The patient suffered from right back pain and her chest X-ray showed a clear round shadow in the middle field of the right lung. Chest computed tomography (CT) showed a 5 x 5 cm tumor in diameter, involving the right 8 rib with destructive changes. After radiation therapy of total 30 Gy to the tumor to obtain the safety surgical margin, we widely resected 10 x 9 cm chest wall with 3 ribs in area under thoracoscopy and performed reconstruction using GORE-TEX Soft Tissue Patch. The pathological and immuno-histochemical diagnosis showed pleomorphic type of MFH. Final result of the tumor negative in surgical margin manifested that our technique of chest wall resection and reconstruction using thoracoscope after the irradiation to the tumor was very safe and useful.     

Resected osteochondroma of the rib in an elderly patient

Solitary osteochondroma of the rib is a rare primary chest wall tumor. Herein, we report a case of a successfully resected osteochondroma of the rib. The patient was a 73-year-old asymptomatic woman who came to our hospital regularly for treatment of hypertension and hyperlipidemia. A checkup chest roentgenogram showed a shadow at the right anterior chest wall consistent with a mass, and computed tomography showed a tumor arising from the right fourth rib. Because it was impossible to exclude completely the diagnosis of a well-differentiated chondrosarcoma, we performed resection of the right anterior chest wall and a re construction with a rigid prosthesis. The post operative course of the patient was unremarkable. The final pathological diagnosis of the rib tumor was osteochondroma.