Subdiaphragmatico-mediastinal lipoma through the foramen of Bochdalek; report of a surgical case

A 53-year-old man was admitted to our hospital for evaluation of chest abnormal shadow at the left cardiophrenic angle. Computed tomography (CT) scan revealed a homogeneous mass of fatty density on the left diaphragm. Magnetic resonance imaging (MRI) demonstrated a well-demarcated tumor mass with a fatty signal intensity and, in the sagittal view, the mass showed continuity into the retroperitoneal fatty tissue. Extirpation of the tumor was performed under thoracoscopic procedure. The tumor was adhesive closely to diaphragm and extended into the retroperitoneal space through the foramen of Bochdalek. Pathologically the tumor was diagnosed as a mature lipoma. This tumor was considered to originated from the retroperitoneal fatty tissue under the diaphragm and to herniate into the mediastinum through the foramen of Bochdalek.     

Chondrosarcoma of the rib

A 73-year-old woman evidencing an abnormal shadow on chest X-ray film since 1993 was admitted after a tumor of the left 8th rib was diagnosed in 2001. Computed tomography showed a low-density mass with coarse calcification arising from the left 8th rib and protruding into the abdominal cavity. The tumor was diagnosed as low-grade chondrosarcoma by incision biopsy and was resected together with the left 7th, 8th, and 9th ribs. The chest wall was reconstructed using Marlex mesh. Histological findings were compatible with Grade I chondrosarcoma. The patient had a long clinical course without distant metastasis thanks to the tumor's low malignancy.     

Positron emission tomography (PET)-computed tomography (CT) suggesting small intestinal metastasis from lung cancer; report of a case

A 75-year-old man admitted to our hospital due to an abnormal X-ray shadow detected during an annual health check-up. Chest computed tomography (CT) revealed 3.0 cm solid nodules with chest wall invasion in the left lung. We could not get a definitive diagnosis by transbronchial lung biopsy or CT-guided needle biopsy. Positron emission tomography (PET)-CT revealed positive findings in the tumor, aortopulmonary window lymph node and splenic flexure. Under a diagnosis of suspected lung cancer, thoracotomy was performed. As intraoperative diagnosis revealed a moderately differentiated squamous cell carcinoma, the patient underwent a left upper lobectomy, mediastinal lymph node dissection, and combined chest wall resection. Pathological stage was T3N2M0, stage IIIA. Ten days after surgery, the patient suffered from ileus and emergent surgery was performed. Subsequent pathological examination revealed lung cancer metastasis in the small intestine.     

Chondrosarcoma of the rib

A 73-year-old woman evidencing an abnormal shadow on chest X-ray film since 1993 was admitted after a tumor of the left 8th rib was diagnosed in 2001. Computed tomography showed a low-density mass with coarse calcification arising from the left 8th rib and protruding into the abdominal cavity. The tumor was diagnosed as low-grade chondrosarcoma by incision biopsy and was resected together with the left 7th, 8th, and 9th ribs. The chest wall was reconstructed using Marlex mesh. Histological findings were compatible with Grade I chondrosarcoma. The patient had a long clinical course without distant metastasis thanks to the tumor's low malignancy.     

Langerhans cell histiocytosis of the rib in adult male

A 57-year-old man was admitted to our hospital with an abnormal shadow on chest X-ray film. Computed tomography (CT) scanning demonstrated a low-density, destructive mass on the right 8th rib. The maximum standardized uptake value of the tumor measured by positron emission tomography (PET) was 2.9, indicating malignancy. Wide resection of the tumor, including the right 8th rib and the 7th to 8th intercostal muscle, was performed. Chest wall reconstruction was achieved with Composix Mesh. The histologic findings revealed proliferation of histiocytes and eosinophil infiltration. No malignant cells were detected in the tumor. Histiocytes stained for S-100 protein and CD1a, compatible with a diagnosis of Langerhans cell histiocytosis (LCH). LCH in the ribs is very rare and difficult to diagnose using CT or PET. Tumor biopsy or resection is needed to diagnose LCH.     

Mediastinal lipoma: Report of a case

We experienced a case of mediastinal lipoma, which is considered to be a relatively rare disease. A 3-year-old girl was referred to Gifu University hospital because of fever and an abnormal shadow on her chest X-ray. The chest X-ray clearly showed a well-delineated tumor shadow which seemed to oppress the diaphragm and the right atrium in the right lower lung area. A computed tomogram (CT) of the chest showed a homogeneous mass localized on the right diaphragm and adjoining the right anterior chest wall and heart. The mass showed a fat density measuring about-100 HU. Magnetic resonance imaging (MRI) showed a high-intensity mass which was almost the same level as the subcutaneous fat on both the T₁-weighted and T₂-weighted images. Thoracotomy was performed and a fatty tumor was found. It arose from the right side of the pericardium and adjoined the diaphragm, the anterior chest wall, and the thymus. There was no adhesion between the tumor and the surrounding organs. It was resected easily and its contents were yellowish and homogeneous. The patient made an uneventful recovery and was discharged 10 days after the operation. Light microscopy showed a lipoma consisting of mature adipose tissue and no malignancy was found.     

Invasive thymoma with thymic cyst; report of a case

A 27-year-old woman was pointed out an abnormal shadow on chest X-ray in 1999. Because of the enlargement of the chest abnormal shadow, she was admitted to our hospital in 2000. Chest computed tomography (CT) revealed anterior mediastinal solid mass with cystic lesion. A thymoma was suspected. The tumor was removed in June 2000, through a longitudinal incision of the sternum. There was a severe adhesion between the tumor and the right brachiocephalic vein. Histological examination revealed a thymoma with thymic cyst. The thymoma had a capsular invasion (stage II). There were few reports for cases of thymoma with thymic cyst.     

A case of giant cell tumor originating from the rib

We have experienced a case of giant cell tumor originating from the rib. A 45-year-old male was admitted to our hospital because of a mass in the left chest wall. A tumor shadow was observed in the left side of chest X ray. Chest CT, bone scintigram showed tumor originating from the left 4th rib. The tumor was suspected giant cell tumor of bone by needle biopsy examination. The tumor was completely resected with chest wall surrounding the tumor. The defect of chest wall was reconstructed with Marlex mesh and the Latissimus dorsi muscle flap. The pathological diagnosis was a giant cell tumor of bone. The patient has been well for two years and one month since surgery, with no signs of recurrence.     

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.     

Schwannoma of the recurrent laryngeal nerve; report of a case

A 57-year-old woman was admitted to our hospital because of an abnormal shadow on her chest X-ray film and a palpable left neck mass. She had a mild cough. Computed tomography (CT) scans and magnetic resonance imaging (MRI) of the chest demonstrated a well-circumscribed, huge mass (approximately 14 cm in diameter) in the left anterior mediastinum. On June 12th, 2000, the mass was resected. During surgery, the tumor seemed to arise from the left recurrent laryngeal nerve. The pathological examination revealed the tumor as a schwannoma. Recurrent laryngeal nerve schwannoma is extremely rare.     

Malignant solitary fibrous tumor of the pleura; report of a case

A 68-year-old female was admitted to our hospital for further examination of abnormal shadow on chest X-ray. Needle biopsy could not establish pathological diagnosis. Three years later, chest computed tomography (CT) revealed the tumor was enlarged. We suspected it was a malignant tumor, and resected by video-assisted thoracoscopy. The tumor occurred from the right middle lobe, and intraoperative diagnosis was malignant tumor. We added middle lobectomy. Histological examination revealed that tumor was malignant solitary fibrous tumor.     

A case of mediastinal liposarcoma]

Primary liposarcomas of the mediastinum are rare neoplasms comprising only 0.13-0.75% of mediastinal tumors. We report a case of liposarcoma arising in the right posterior mediastinum. A 74-year-old man without symptoms was admitted to our hospital for evaluation of an abnormal shadow on chest roentgenogram. Computed tomogram (CT) and magnetic resonance (MR) imaging revealed a mediastinal tumor. The tumor was surgically removed, and the diagnosis of well-differentiated liposarcoma was established. MR imaging was superior to CT in evaluation of tumor extent, but not in differential diagnosis as liposarcoma or lipoma.     

Large cell carcinoma with neuroendocrine morphology of the lung

We experienced a surgical case of large cell carcinoma with neuroendocrine morphology (LCCNM) of the lung. A 76-year-old man was admitted to our hospital because a routine chest X-ray examination had revealed a nodular shadow in the left lung field. 18F-fluorodeoxyglucose positron emission tomography showed accumulation of fluorodeoxyglucose in an area corresponding to the shadow. Transbronchial lung biopsy failed to give a definitive diagnosis, therefore, open lung biopsy was performed because of suspected lung cancer. Needle biopsy was performed, and the tumor was diagnosed as large cell neuroendocrine carcinoma by rapid intraoperative pathological examination. As sampling of hilar lymph nodes revealed no metastasis, left upper segmentectomy was performed for severe obstructive pulmonary disease. Immunohistochemical examination finally diagnosed the tumor as LCCNM. The patient is doing well without recurrence at ten months after surgery.     

Pleural lipoma: report of a case

Although lipomas are the most common form of the benign neoplasm, occurrence within the thoracic cage is uncommon, and lipomas originating from the pleura are very rare. We report an unusual case of a 63-year-old male whose serial chest X-ray demonstrated an abnormal shadow of which size was increasing. A chest wall tumor was suspected based on the findings of computed tomography (CT) of the thorax. The tumor was resected by video-assisted thoracoscopic surgery and the patient remains well with no recurrence 4 years postoperatively. The resected tumor was a yellowish pleural mass and the pathological diagnosis was a benign lipoma. It is possible to make a diagnosis of lipoma preoperatively by CT and magnetic resonance imaging (MRI), however, the correct differential diagnosis of lipoma and liposarcoma is imperfect only by radiological findings necessitating surgical removal if possible. However, in view of the imperfect differentiation between lipoma and liposarcoma, surgical treatment should be considered.     

Surgically removed thoracolithiasis: report of two cases.

Thoracolithiasis is a rare condition with only 12 cases of surgically removed nodules reported in the literature. We report 2 additional cases. Case 1: A 19-year-old male admitted with an abnormal shadow on a chest X-ray. Computed tomography (CT) revealed a nodule in the right lower lung lobe. The material extirpated by thoracoscopy was milky white, glossy, and 1.6 cm in diameter. Histopathologically, it consisted of fatty necrotic tissue covered with hyalinized fibrous tissue. Case 2: A 78-year-old female, with a past history of breast cancer, admitted with an abnormal shadow on chest X-ray. CT revealed a nodule in the left lung S(1+2) segment, of which transbronchial biopsy findings indicated primary lung adenocarcinoma. Exploratory thoracoscopy incidentally revealed some pearly material, 0.4 cm in diameter, in the thoracic cavity. They were extirpated during left upper lobectomy for lung cancer; all of them demonstrated concentric hyalinized fibrous tissue. Thoracic surgeons should consider this condition in the differential diagnosis of a peripheral pulmonary nodule.     

Chondrosarcoma of rib origin; report of a case

Chondrosarcoma of rib origin is rare. A 50-year-old man without symptom was pointed out an abnormal shadow on chest X-ray. Computed tomography (CT) showed a low density mass arising from the right chest wall, and a CT-guided needle aspiration biopsy disclosed the tumor consisted of cartilage matrix with a partial necrosis. We suspected the tumor to be a chondrosarcoma of rib origin and performed a wide resection with the right 3rd and 4th ribs. The defect of the chest wall was repaired with double prolene mesh. Histological examination revealed grade 2 chondrosarcoma. Postoperative course has been uneventful for 25 months.     

A case of leiomyoma of the chest wall]

A case report of a leiomyoma of the chest wall is presented. So far as we examined, this is the first case of the leiomyoma of the chest wall in Japan. A 40-year-old woman was admitted to our hospital because of an abnormal shadow in the right upper lung area in a chest X-ray film. The thoracic CT and MRI demonstrated a tumor of the chest wall projecting into the thoracic cavity. The tumor was excised. Histological examination indicated that the tumor was a benign leiomyoma. This tumor seems to originate from the wall of the small vessels histologically. The patient's postoperative course is uneventful.     

Gigantic thymolipoma

A 48-year-old woman with an abnormal shadow in chest radiography during an annual physical examination was found by chest computed tomography to have a large fatty mass lesion found to be diagnosed as a gigantic lipoma. Histopathological diagnosis was found to be benign thymolipoma consisting of mature fatty tissue and hyperplastic thymic tissue structures with Hassall,s corpuscles. Although the diagnosis is supported by imaging studies that demonstrate fat and soft tissue within the tumor, variations occur in computed tomography appearance. We suggest that surgical excision be considered when a gigantic intrathoracic lipomatous mass is in scanning as in this case.     

Pulmonary adenocarcinoma of the fetal lung type; report of a case

An asynptomatic 58-year-old male was admitted to the hospital because of an abnormal nodule in the left lung field on screening chest X-ray. Chest computed tomography (CT) showed a tumor shadow mass in the left lower lobe. Open biopsy was performed to diagnose the mass. The cytological diagnosis was low-grade malignant adenocarcinoma, underwent left lower lobectomy. The histological diagnosis was pulmonary adenocarcinoma of the fetal lung type which was one of pulmonary blastoma (PB). Recently, the concept of pulmonary blastoma has changed. It will be useful to investigate the old PB's case reports to classify new concept.     

The saccular coronary aneurysm associated with coronary artery to pulmonary artery fistulae

Coronary artery fistulae are relatively rare congenital anomalies. Those associated with saccular coronary artery aneurysms are even rarer. Including the current case, only 65 such cases have been reported in Japan. A 62-year-old female was admitted to our hospital for evaluation of abnormal shadow on the chest X-ray. The enhanced chest computed tomography (CT) scan demonstrated a giant saccular coronary aneurysm on the left side of the pulmonary artery. Multi-detector row CT (MDCT) scan demonstrated the coronary artery aneurysm was connected to the left anterior descending artery. Coronary angiography revealed 2 aneurysms with bilateral coronary artery to pulmonary artery fistulae. The patient underwent aneurysmectomy and ligation of fistulae under cardiopulomonary bypass. The postoperative course was uneventful and postoperative coronary angiography revealed complete resection of the aneurysms and only slight blood flow through the fistulae. She was discharged on the 10th postoperative day.