Contralateral pneumothorax in bullous lung after pneumonectomy: report of two cases

Contralateral pneumothorax after pneumonectomy is potentially fatal. We experienced two cases of right pneumothorax after left pneumonectomy in which the patients had multiple bullae in the right lung. Case 1 involved a 49-year-old man with non-small-cell lung cancer (NSCLC) who underwent left pneumonectomy after induction chemoradiotherapy. Eleven months after surgery, he had pneumothorax and was treated with chest tube drainage and pleurodesis. He was discharged but died of recurrent pneumothorax 1 month later. Case 2 involved a 57-year-old man with NSCLC who had left pneumonectomy. Five months after surgery, he had pneumothorax and was treated with chest tube drainage. Because of prolonged air leak, ligation of the ruptured bulla was performed with a percutaneous cardiopulmonary support system on standby. No pneumothorax recurrence occurred for 2 years. Although management of pneumothorax after pneumonectomy is challenging, surgical intervention may be useful and necessary especially when there is high risk of recurrent pneumothorax.     

A case of primary leiomyosarcoma of the chest wall successfully resected under the video-assisted thoracoscopic approach.

We report a case of a 62-year-old woman with primary leiomyosarcoma of the chest wall which was successfully resected under the video-assisted thoracoscopic approach. The disease was found during the treatment for a malignant melanoma of the left heel. On the preoperative CT images, the lesion was suspected to be a metastasis of the malignant melanoma. The thoracoscopic surgery revealed that the tumor originated from the parietal pleura, and it was resected with a 5-mm margin of normal pleura. Histopathologically, the tumor was diagnosed as low-grade leiomyosarcoma. Since no residual tumor cells were proven in the resected margins histologically, further resection was not performed. At present, she is alive and well with no sign of recurrence of leiomyosarcoma two years and one month after operation. Thoracoscopic surgery is worth trying for accurate diagnosis of and effective treatment for a chest lesion without apparent invasion of the chest wall on the preoperative CT images.     

Two cases of thymic carcinoid

Two cases of thymic carcinoid tumor were reported. Case 1 was 64-year-old male who was admitted to our hospital with a complaint of dyspnea. He was proved to have a huge anterior mediastinal tumor by chest X-ray and chest CT. After radiation therapy, the tumor was resected on February 5, 1981. Pericardium was partially resected and showed tumor invasion. Sixty-four days after operation, he died due to respiratory insufficiency. Case 2 was 71-year-old male who was pointed out to have an abnormal shadow by X-ray mass screening and was admitted to our hospital. Chest X-ray and chest CT revealed the presence of an anterior mediastinal tumor. Resection of the tumor was done on February 13, 1986. Although the tumor showed mediastinal lymph node metastasis and invaded to the pericardium and the right lung, it was resected completely. Cytological examination of pericardial effusion showed tumor cells at the time of resection. He is now quite well and without any evidence of recurrence 3 year and 1 months after operation. Histopathologically, the tumors of two cases consisted of relatively uniform cells with abundant clear or slightly eosinophilic cytoplasm and regularly and centrally located nuclei. Mitotic figures were occasionally seen in both cases. Many tumor cells were positively to Grimelius stain. On the other hand, Fontana-masson stain was negative. Immunohistochemically, the tumor cells were positively stained with anti-NSE and anti-GRP antibodies in Case 1 and with anti-NSE antibody in Case 2.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Thymic carcinoma (mixed small cell undifferentiated squamous cell carcinoma); report of a case

A 52-year-old man was admitted to our hospital on October, 1997 with complains of left anterior chest pain. A chest X-ray and computed tomography on admission showed evidence of a mass in the left anterior mediastinum. The patient was treated with combination chemotherapy [cisplatin (CDDP), etoposide (VP-16)] and radiation therapy (2 gray x 25 days), preoperatively. Median sternotomy revealed a tumor invading into the left anterior chest wall, the pericardium, and partial pleura. The tumor was extirpated with combined resection of invaded organs. Microscopically and immunohistochemically, the tumor was diagnosed mixed small cell and undifferentiated squamous cell carcinoma documented by Snover et al. The patient was discharge on March 1998, but 2 years later after operation, he was dead by recurrent. We reported a rare case of thymic carcinoma.     

Nonmalignant pericardial effusion associated with thymic cancer

We report a case of thymic carcinoma with massive pericardial effusion in a 74-year-old man. This patient with dyspnea was referred to our hospital because of pericardial effusion detected by echocardiography. A chest computed tomography and magnetic resonance imaging showed an anterior mediastinal mass measuring 8.0 × 5.0 cm with massive pericardial effusion. The mass lesion was suggestive of thymic carcinoma or invasive thymoma. Initially, he underwent pericardial drainage. The collected fluid was serous and yellow, and cytological examination found no malignant cells. The tumor with partial pericardium was resected. Histopathological findings confirmed the lesion to be squamous cell carcinoma of the thymus. The etiology of a massive nonmalignant pericardial effusion associated with thymic carcinoma warrants further studies. The patient is alive without recurrence and without pericardial effusion at 3 years to date after the operation. Not all pericardial effusion associated with thymic cancer involves malignant effusion.     

Rare pleural recurrence of typical pulmonary carcinoid tumor 30 years after lobectomy

A 68-year-old man, who underwent a left lower lobectomy for a typical carcinoid tumor 30 years previously, presented with a 2-year history of left-sided chest pain. A computed tomographic scan, an octreotide scan, and pleural biopsy all showed recurrence of carcinoid tumor in the pleura. He underwent left chest wall resection, and histopathologic examination confirmed the diagnosis of typical carcinoid tumor. A review of the literature indicates that this is only the second reported case of pleural recurrence after previous complete resection of typical pulmonary carcinoid tumor. This case is even more unusual in that the recurrence presented so long after surgery.     

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.     

Huge localized mesothelioma of the diaphragm in a 17-year-old Female — a case report with calculated tumor volume doubling time —

An operative case of localized mesothelioma of the pleura developed in a 17-year-old female was reported. She was admitted to our hospital complaining of right chest pain. A chest X-ray film showed a huge mass in the right lower field of the lung. After the embolization of the right inferior phrenic artery, which was the main feeder to the tumor, it was then successfully resected combined with the right diaphragm and the right lower lobe of the lung. Histologicaly, the tumor was diagnosed as benign localized mesothelioma (solitary fibrous tumor of the pleura). Further histological and immunohistochemical study revealed that it had developed from the connective tissue under the parietal mesothelium of the diaphragm. As chest roentgenograms had been undertaken during past two years, the tumor volume doubling time was calculated at 153 days. Despite the short tumor volume doubling time as like primary lung cancer, she is alive without recurrence 5 years after the operation.     

Metastatic renal tumors: clinical report of three cases and review of 136 cases including 38 cases from the Japanese literature

Three cases of metastatic renal tumor are reported. The first case was of a 61-year-old man, who had a Miles' operation for rectal adenocarcinoma 30 months before, and suffered from high fever and right flank pain. Right nephrectomy was carried out and the kidney was found to contain an adenocarcinoma identical to the one previously removed from the rectum. He died 1 year after nephrectomy. The second case was of a 35-year-old man, who had undergone left pneumonectomy for a squamous cell carcinoma of the bronchus. One month later, he was readmitted with cloudiness of consciousness and high fever. Investigations revealed right kidney, adrenal gland and brain malignancies, and which were ectomized totally. On pathological examination all ectomized tissues were metastatic squamous cell carcinoma. He died 1 month after the second operation. The third case was of a 48-year-old man, who had undergone left pneumonectomy for a squamous cell carcinoma of the bronchus. One year after pneumonectomy, abdominal CT showed a left renal tumor. Right nephrectomy was performed and pathological examination revealed a metastatic squamous cell carcinoma. He is now alive 4 months after nephrectomy without any sign of recurrence. A total of 136 cases of metastatic renal tumors including 38 cases from the Japanese literature, are reviewed.     

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.     

Thoracoscopic resection for benign solitary fibrous tumor of the parietal pleura

We have experienced thoracoscopic surgery for benign solitary fibrous tumor of the parietal pleura. A 46-year-old woman was admitted to our hospital because of chest abnormal shadow. Under thoracoscopy the tumor that was connected to the parietal pleura with a wide pedicle was completely resected with combined parietal resection of the pleura. Pathological diagnosis was a benign solitary fibrous tumor developed from the connective tissues under the parietal pleura. Thoracoscopic surgery is well indicated for a solitary fibrous tumor and wide excision of the tumor with combined resection of the pleura is important to prevent a local recurrence.     

Sarcomatoid pleural mesothelioma presenting as posterior mediastinal tumor with dysphagia

Case 1: A 46-year-old man with dysphagia, chest pain and cough admitted to our department. Radiological studies demonstrated a solid mass with a maximal diameter of 5cm at the posterior mediastinum. The tumor was resected, then postoperative radiotherapy (60Gy) and chemotherapy were performed. Results of histological and immunohistochemical study showed that the tumor consisted of sarcomatoid mesothelioma. The patient died of recurrence with bone metastasis 6 months after surgery. Case 2: A 76-year-old man with dysphagia, chest pain and cough admitted to our department Radiological studies demonstrated a solid mass with a maximal diameter of 12cm in the posterior mediastinum. accompanied by abundant effusion in the bilateral pleural cavities. The patient underwent open biopsy and histological and immunohistochemical study showed that the tumor consisted of sarcomatoid mesothelioma. The patient died of multiple organ failure on the 1st postoperative day. We report extremely rare cases of sarcomatoid mesothelioma that appeared to be posterior mediastinal tumor before surgery, and discuss the difficulty of diagnosing sarcomatoid mesothelioma with atypical clinical manifestations.     

Giant cardiac metastasis of myxoid liposarcoma causing cardiac tamponade; report of a case

We report a very rare case of cardiac metastasis of myxoid liposarcoma. A 55-year-old man presented with dyspnea. Two and a half years ago, he underwent resection of myxoid liposarcoma in the left thigh. Magnetic resonance imaging (MRI) revealed a giant tumor occupying the pericardiac cavity and pressing the heart and consequently causing cardiac tamponade. The patient underwent surgery through a left thoracotomy approach. The pericardiac cavity was filled with a giant tumor with a stalk from the right ventricle and 2 small nodules on the main pulmonary artery. He was relieved from the symptom: however, he had a recurrence of the tumor at the same site 5 months after the operation. He underwent surgery for the removal of the second tumor; however, he died 49 days after the operation. Although cardiac metastasis is a very rare condition, its awareness is essential for careful long-term follow-up for the early detection of a metastatic cardiac liposarcoma after the resection of the primary tumor.     

Rapidly Growing Primary Cardiac Leiomyosarcoma: Report of a Case

Primary cardiac leiomyosarcomas are very rare. A 19-year-old man was admitted to a local hospital with dyspnea and hemoptysis. He was later transferred to our hospital because of his worsening dyspnea. An enhanced chest computed tomography scan demonstrated a large mass in the left atrium. A transthoracic echocardiogram showed a large mobile mass in the left atrium. The tumor was totally resected. The pathohistological examination showed leiomyosarcoma. The tumor rapidly recurred, and a second and third operation were performed. After the third operation, the patient was treated with radiotherapy. There was no local recurrence but multiple distant metastases were found 2 months after completion of radiation therapy. Received: October 28, 1999 / Accepted: March 24, 2000 An erratum concerning a duplicate publication of this article is available at .     

En bloc (non-chest wall) resection for bronchogenic carcinoma with parietal fixation. Factors affecting survival

Seventy-three patients (57 men and 16 women) underwent en bloc resection of lung and attached parietes between 1970 and 1982. All patients had documented malignant pleural invasion. Chest wall parietal pleura was invaded in 33 patients, pericardium in 14, phrenic or vagus nerve in nine, left atrium in five, superior vena cava in four, esophagus in two, diaphragm in one, and multiple structures in five. No patient underwent chest wall resection. Parietal pleurectomy was performed in all patients with involvement of the chest wall parietal pleura; 37 lobectomies and 36 pneumonectomies were performed. Operative mortality was 12.3%. The actuarial overall 5 year survival rate (Kaplan-Meier method) was 39.7%. We conclude that en bloc resection for primary bronchogenic carcinoma with invasion of adjacent intrathoracic structures, although associated with a significant mortality, can be performed with a reasonable likelihood of long-term survival.     

Two cases of resected esophageal mucoepidermoid carcinoma

Two cases of resected esophageal mucoepidermoid carcinoma are described herein. Case 1, a 56-year-old man, had an ulcerous lesion of 6.5 cm in length, in the lower esophagus and a small skin tumor of 0.5 cm in diameter, in the forehead. Pathologic studies of both tumors revealed mucoepidermoid carcinoma. This case was therefore considered to be a primary tumor of the esophagus with skin metastasis. The patient was alive and well when last seen, 15 months after his operation. Case 2, a 66-year-old man, had a long ulcerous lesion of 9.0 cm in length, in the mid-thoracic and lower esophagus. The tumor had invaded the aorta and the membranous portion of the left main bronchus, and therefore complete resection was impossible. The patient died of mediastinal recurrence only 3 months after his operation in spite of postoperative irradiation. A review of the literature showed that this tumor has a much greater incidence of rapid recurrence and distant metastasis, regardless of treatment, than usual squamous cell carcinoma of the esophagus. In order to establish and accurate diagnosis of mucoepidermoid carcinoma, alcian blue and/or mucicarmin staining of the endoscopic biopsy specimen should be performed if the tumor contains both glandular and squamous cell carcinoma.     

A case of retrovesical tumor

A 53-year-old man was admitted with complaint of left lower abdominal pain. Retrovesical tumor was suggested after digital examination and imaging diagnosis. At operation, the encapsulated tumor occupied the retrovesical space, but was not adhered to the adjacent organs such as prostate, seminal vesicles, bladder and rectum. The entire tumor was successfully resected. Histopathological report revealed a mature teratoma. He is alive without recurrence at 1 year after operation. This is the second case of retrovesical teratoma in the Japanese literature.     

Two cases of resected esophageal mucoepidermoid carcinoma

Two cases of resected esophageal mucoepidermoid carcinoma are described herein. Case 1, a 56-year-old man, had an ulcerous lesion of 6.5 cm in length, in the lower esophagus and a small skin tumor of 0.5 cm in diameter, in the forehead. Pathologic studies of both tumors revealed mucoepidermoid carcinoma. This case was therefore considered to be a primary tumor of the esophagus with skin metastasis. The patient was alive and well when last seen, 15 months after his operation. Case 2, a 66-year-old man, had a long ulcerous lesion of 9.0 cm in length, in the mid-thoracic and lower esophagus. The tumor had invaded the aorta and the membranous portion of the left main bronchus, and therefore complete resection was impossible. The patient died of mediastinal recurrence only 3 months after his operation in spite of postoperative irradiation. A review of the literature showed that this tumor has a much greater incidence of rapid recurrence and distant metastasis, regardless of treatment, than usual squamous cell carcinoma of the esophagus. In order to establish and accurate diagnosis of mucoepidermoid carcinoma, alcian blue and/or mucicarmin staining of the endoscopic biopsy specimen should be performed if the tumor contains both glandular and squamous cell carcinoma.     

Chest wall epithelioid sarcoma

Two relatively rare cases of epithelioid sarcoma located in the chest wall are reported herein. The first was a tumor, 3.8 x 5.5 x 2.4 cm in size, originating in the left erector spinae muscle of a man 64 years of age. He experienced local recurrence 3 times even after wide resections, and he died of systemic metastasis 22 months after the initial surgery. The second was a tumor, 2.2 x 2.0 x 1.5 cm in size, originating in the left seventh intercostal muscle of a woman 24 years of age. A metastatic tumor occurred in the same muscle, and wide resection including the seventh and eighth intercostal muscles was performed. There has been no recurrence for 1.5 years since surgery. Metastasis of chest wall epithelioid sarcoma in the muscle in which the primary lesion resides should be considered, even if the primary lesion is small.