Adenoid cystic carcinoma of lower lobe of right lung: report of a case

A 69-year-old male was admitted to the hospital for further examination of an abnormal shadow in the right lower lung fields. He was previously under medical treatment for right thoracic empyema. Chest computed tomography (CT) showed a solitary mass, 4.5 cm in diameter and broncofiberscopy evidenced a tumor in the right lower bronchus. The biopsy was performed and the tumor was diagnosed as a pleomorphic adenoma. Intraoperativefinding showed the tumor was 6 cm in gross, extended to the left atrium, and a daughter tumor was palpable in the middle lobe. The middle and lower lobe were resected. The tumor was located in S9, S10, 6 x 4 x 3.5 cm in size, 2 daughter tumor was found in the middle lobe, the pulmonary vein was thickened by tumor invasion. Pathohistologically, main tumor and daughter tumor showed malignant feature, were compatible with adenoid cystic cancer. Four years after operation, he is still now alive with home oxygen therapy.     

A case report of primary malignant fibrous histiocytoma of the lung]

In this paper, a case of a 59-year-old female of primary malignant fibrous histiocytoma (MFH) of the lung is reported. The patient, who had dyspnea as a main complaint, presented with an abnormal shadow in the chest about 20 years ago, and rapid increase of the shadow has been recognized from one year ago. A pulmonary tumor of the left upper lobe was diagnosed by chest CT, bronchography, pulmonary arteriography. A left pneumonectomy was performed and metastases in lymph nodes and pleural dissemination were recognized. The tumor was 11 X 8 X 6 cm, white, multiple nodular, and solid with a clear border. Histologic examination showed the storiform pleomorphic type of MFH mixed with fibroblastoid cells and histiocytoid cells. Ga scintigram, bone scintigram, and CT conducted before and after the surgery did not show metastasis, but the patient died due to respiratory insufficiency caused by metastasis to the right pleura at 9 months after surgery.     

A case of leiomyosarcoma of the scrotum: chemotherapy with anti-cancer agents was effective for the lung metastasis

A 59-year-old male was referred to our hospital with the chief complaint of a painless scrotal mass. A 6 X 4.5 X 4 cm elastic hard mass with irregular surface was palpable in the right scrotum. We diagnosed a tumor in the right scrotum and resected the tumor surgically. Histopathologically, the tumor was liposarcoma of the right scrotum. Lung tumors were found 20 months after resection of the origin. Systemic chemotherapy with new anti-cancer agents (Paclitaxel and Gemcitabine) was performed. The main tumor was reduced to 56% in its diameter after 6 courses of chemotherapy. Exclusion of the right middle and lower pulmonary lobe was performed. The final pathological diagnosis of the lung tumor was metastatic liposarcoma.     

Long-term survival after removal of a malignant peripheral nerve sheath tumor originating in the anterior mediastinum

Malignant peripheral nerve sheath tumors (MPNSTs; malignant schwannomas) rarely occur in the anterior mediastinum, and their prognosis is poor. A 75-year-old man was referred to our hospital for examination of an anterior mediastinal tumor. A computed tomography-guided percutaneous needle biopsy revealed only fibrosis. The tumor was completely excised via a median sternotomy with partial resection of the pericardium and right upper lobe of the lung. Thereafter, the tumor was diagnosed as a storiform-pleomorphic type of malignant fibrous histiocytoma. At 1 year after the surgery, a distant metastasis was found in the interlobular space between the right middle and lower lobes. The tumor was completely excised via a right posterolateral thoracotomy. Reexamination of the primary and secondary tumors revealed an MPNST. No recurrence was found up to 5 years after the second surgery without adjuvant chemotherapy or radiation therapy. However, he died from multiple lung metastases after 6 years.     

Endobronchial hamartoma with obstructive pneumonia due to <Emphasis Type="Italic">Nocardia asiatica</Emphasis>

A 60-year-old man who had diabetes had a history of hospitalization for pneumonia in the right lower lobe at the age of 57 years. He visited our facility complaining of fever and cough. He was admitted owing to pneumonia in the right lung. Computed tomography and bronchoscopy performed after admission revealed a tumor in the right basal bronchus. Nocardia asiatica was detected in a sputum culture. Complete resection of the bronchial tumor could not be achieved with a high-frequency snare, although the patient was preoperatively diagnosed as having hamartoma. The patient subsequently underwent resection of the right lower lobe due to his deteriorated clinical condition. The postoperative course was favorable, and there has been no recurrence of nocardiosis or bronchial hamartoma for 3 years.     

Metastatic lung tumor: report of two cases

We herein report 2 cases of metastatic lung tumor. The first case was a 59-year-old female, who had undergone a left radical mastectomy for the treatment of breast cancer 18 years before. She was found to have a pulmonary nodule in the left lower lobe on the routine chest radiograph. She underwent a video-assisted thoracic surgery (VATS) partial resection of the left lower lobe. Tumor was diagnosed as a lung metastasis of the breast cancer microscopically. The second case was a 77-year-old man, who had undergone a right nephrectomy for the treatment of renal cell carcinoma. He was found to have 2 nodules in the right lung (1 in the middle lobe and the other in the lower lobe) on the follow-up computed tomography (CT) scan of the chest. He underwent VATS partial resections of the right middle and lower lobes. While the tumor in the lower lobe was diagnosed as a lung metastasis of the renal cell carcinoma, the tumor in the middle lobe turned out a primary lung cancer.     

Primary malignant fibrous histiocytoma of the diaphragm: Report of a case

We present herein the case of a 55-year-old man with primary malignant fibrous histiocytoma (MFH) of the diaphragm. He was admitted to our hospital with right anterior chest pain, where diagnostic imaging showed a huge tumor in the right diaphragm with a tumor thrombus in the vena cava, spreading to the left lobe of the liver and the pericardium. Although invasion into the right lung was identified at the time of surgery, the entire tumor was removed. Histopathological examination of the resected specimen revealed the characteristics of MFH. We discuss the clinical features of this patient in comparison with the few previous reports on MFH of the diaphragm.     

Pleomorphic carcinoma of the lung; report of a case

A 66-year-old female complained of cough, and was referred to our hospital. Chest radiography and computed tomography (CT) showed a tumor mass near the right hilum and atelectasis of the middle lobe. Bronchoscopy revealed a whitish polypoid tumor obstructing the middle lobe bronchus. Histology by punch biopsy suggested adenocarcinoma Right upper and middle lobectomy was performed, due to the direct invasion of the tumor from the middle lobe to the upper lobe. Histological findings showed adenocarcinoma comprised of spindle cell component, finally diagnosing as pleomorphic carcinoma of the lung. After the operation, systemic chemotherapy, including paclitaxel and carboplatin was performed. About 42 months after operation, the patient died of multiple brain metastases.     

A case of intrapulmonary schwannoma and a review of the Japanese literature

A 61 year-old male with abnormal shadow on chest X-ray was admitted. Right upper lobectomy was performed on the suspicious diagnosis of benign lung tumor. The tumor arising from right upper lobe was 5 X 6 X 4.5 cm in diameter. The histological diagnosis was schwannoma. Intrapulmonary schwannoma is an extremely rare and we have found 13 reported cases among in Japanese literatures.     

21-year-old man with squamous cell carcinoma of the lung

Lung cancer among people in their twenties is rare and accounts for only 0.1-0.4% of all cases. We describe a case of squamous cell carcinoma of the lung in a 21-year-old man. The otherwise healthy patient presented with a 1 month history of cough. Chest radiography showed a well-defined round mass 5 cm in size in the right lower lobe. Computed tomography also showed a 3 cm hilar lymph node. Bronchoscopy revealed a white polypoid mass obstructing the right basal bronchus. Transbronchial biopsy revealed poorly differentiated squamous cell carcinoma of the lung. Clinical diagnosis was T2N1M0, stage IIB lung cancer. Right lower lobectomy with mediastinal lymph node dissection was performed. Lymph node metastases were proven histologically in the pretracheal, subcarinal, hilar, and intrapulmonary regions. Pathological diagnosis was T2N2M0, stage IIIA lung cancer. Endobronchial and mediastinal lymph node metastases were found 2 months after surgery. He received 3 rounds of chemotherapy with cisplatin and docetaxel and irradiation to the right hilum and mediastinum at a total dose of 60 Gy in 30 fractions. He is alive 6 months after surgery.     

A case of fibrous histiocytoma of the appendix with twisted stalk

A 74-year-old man consulted this hospital with the chief complaint of lower right abdominal pain on February 13, 1998. He was hospitalized, subjected to abdominalechography and CT, and diagnosed as having subileus caused by an intraperitoneal tumor. Surgery was performed on February 25, 1998. When the abdomen was incised, a chicken egg-sized tumor at the end of theappendix were found. In addition, the stalk of the appendix was twisted. Appendectomy was therefore performed. Upon histopathological examination, it was found that the submucosal tumor originated at the end of the appendix, and proliferation of spindle-shaped fibroblast-like cells and histocytic oval cells was observed in the tumor. Since various histiocyte markers were positive upon immunohistological examination, the tumor was considered to be of histiocytic origin. However, the tumordid not exhibit polymorphism, heteromorphism, or mitotic figures which would confirm a diagnosis of malignant fibrous histiocytoma. It was thus diagnosed as a fibrous histiocytic tumor on the borderline between malignant and benign. We report the present case because the occurrence of a primary fibrous histiocytoma in an appendix of which the stalk is twisted is very rare.     

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.     

Isolated endobronchial metastasis of Wilms' tumor

Isolated endobronchial metastasis from extrapulmonary solid organ was rarely reported in previous literature. We report an isolated endobronchial metastasis of Wilms' tumor in a 4-year-old boy. He underwent right nephrectomy on account of Wilms' tumor at the age of 3 years. We performed a wedge resection of a metastasis to the right lower lobe of the lung a year later, followed by chemotherapy and irradiation of the involved lung over a period of 30 weeks. One and a half years later, he developed obstructive pneumonitis of the left lung. Fiberoptic bronchoscopy identified a tumor at the left main bronchus with near total bronchial obstruction, compatible with findings on a computed tomographic scan. Rigid bronchoscopy was performed to core out the obstructing tumor. It was reported as a metastatic Wilms' tumor. Successful reexpansion of the left upper lobe was achieved and he was discharged uneventfully, followed by adjuvant chemotherapy.     

Malignant fibrous histiocytoma of the spermatic cord: a case report

The patient was a 69-year-old male who complained of a painless mass in the right inguinal area of two weeks duration. Under the diagnosis of spermatic cord tumor, right high orchiectomy was done. The excised tumor was 3 X 2 X 2 cm. The histological diagnosis was malignant fibrous histiocytoma. The patient has been well without any signs of recurrence or metastasis 12 months after operation.     

Malignant fibrous histiocytoma originating in a renal capsule: a case report]

We report a case of malignant fibrous histiocytoma originating in a renal capsule. A 43-year-old woman was admitted with a chief complaint of right lower abdominal pain. Physical examination was unremarkable. Serum C-reactive protein and erythrocyte sedimentation rate increased to 3.8 mg/dl and 60 mm/hr., respectively. Computed tomography (CT) and magnetic resonance image (MRI) showed a heterogeneous enhanced mass, 4 x 9 x 13 cm in size, in contact with the lateral part of the right kidney. Selective right renal arteriography revealed a hypovascular tumor, the main feeding artery of which was the right adrenal artery. Preoperative clinical diagnosis was a retroperitoneal sarcoma and transabdominal tumor resection was performed. The adhesion between the tumor and the right kidney was so severe that right nephrectomy was also necessary for a radical surgery. The tumor, measuring 13 x 9 x 6 cm, was located laterally adhering to the right renal capsule. Microscopic examination of the tumor demonstrated spindle-shaped fibroblast-like cells arranged in a storiform pattern with fibrous stroma and clusters of rounded histiocyte-like cells and pleomorphic giant cells with bizarre nuclei. Histopathological diagnosis was malignant fibrous histiocytoma arising from the renal capsule and there was no tumor invasion to renal parenchyma. No adjuvant therapy was performed but she has remained well for 31 months since the operation without evidence of disease.     

Pulmonary pleomorphic carcinoma

Pleomorphic carcinoma is a rare primary pulmonary malignancy. We report 2 surgical cases of pulmonary pleomorphic carcinoma. The first case was a 71-year-old male. Chest computed tomography (CT) showed a rapidly growing tumor with irregular density. Transbronchial lung biopsy revealed the tumor to be malignant. Left lower lobectomy was performed. Pathological diagnosis was pleomorphic carcinoma (pT2N2M0, stage IIIA). He died 8 months after surgery due to brain metastasis and mediastinal lymph node metastasis. The second case was a 74-year-old male who complained of bloody sputum. Chest CT showed a tumor with cavity in the right middle lobe. Brushing cytology under bronchofiberscopy revealed atypical cell. Right middle lobectomy and partial resection of the right lower lobe were performed. Pathological diagnosis was also pleomorphic carcinoma (pT2N0M0, stage IB). He has no findings of recurrence nor metastasis 15 months after the operation.     

A case of malignant fibrous histiocytoma of the cecum

A case of primary malignant fibrous histiocytoma (MFH) of the cecum was reported. Patient was a 52-year-old female, and complained of right lower abdominal pain. The barium enema and abdominal computed tomography demonstrated a localized mass involving the entire circumference of the cecum. Right hemicolectomy was performed and the resected specimen revealed a tumor of 8 X 6 X 5 cm in size extending to the entire circumference of the cecum. The histopathological examination revealed a storiform pattern, which was diagnostic of MHF. The tumor proliferated chiefly in the subserous tissue and partially infiltrated the tunica muscularis propria. The postoperative course was uneventful and she showed no sign of recurrence at 15 months after operation. This is the ninth reported case of primary MFH in digestive organs.     

A case of epidermoid cyst of the testis

A 32-year-old business man was admitted with the chief complaint of a right testicular mass without pain. Laboratory findings including serum AFP, HCG, and beta-HCG were within normal limits. Right high orchiectomy was performed under the diagnosis of testicular tumor. The cyst was located at the middle of the testis and was 3.5 X 3.0 X 2.0 cm in size. The cut surface of the tumor revealed a fibrous capsule with a keratin mass in it. Histological diagnosis was a benign epidermoid cyst. This case seems to be the 56th case of epidermoid cyst of the testis reported in the Japanese literature.     

Malignant fibrous histiocytoma of the perirenal tissue: report of a case--a statistical study of 58 cases of urological malignant fibrous histiocytoma in Japanese literature

A 78-year-old man was admitted in June 18, 1982 with a two-year history of general fatigue and loss of appetite. Physical examination revealed a child's head sized, firm, not tender, right upper quadrant mass which had an almost smooth surface and had respiratory displacement. Preoperative diagnosis was a hypovascular renal tumor presenting at the lower part of the right kidney. Right nephrectomy was performed on July 6, which displayed a specimen 1,300 g and 17 X 12 X 10 cm. The light yellow tumor appeared between the renal parenchyma and large fatty masses. The tumor was histologically diagnosed as storiform-pleomorphic malignant fibrous histiocytoma (MFH) and disclosed infiltration of both the fibrous renal capsule and adjacent perirenal fatty tissue. There was no invasion of the tumor into the renal parenchyma and the case was considered to arise from the fibrous renal capsule or the perirenal tissue. Although he had been treated with ifosfamide and adriamycin three times after operation and with immunotherapy of 3 g of PSK per day for about five months, he died three years and one month after operation. We reviewed 58 cases of MFH arising from the retroperitoneum and genitourinary tract (urological MFH) in the Japanese literature.     

Recurrent localised pneumonia due to bronchial infiltration in a patient with chronic lymphocytic leukaemia.

A woman with chronic lymphocytic leukaemia developed pneumonia on five occasions in the right middle lobe in the course of 27 months. Bronchoscopy disclosed concentric narrowing of the middle lobe bronchus by leukaemic infiltration.