A case report of a mediastinal bronchogenic cyst with back pain

We performed thoracoscopic surgery for a mediastinal bronchogenic cyst with complaining of back pain. The patient, a 38-year-old male, was admitted with an abnormal shadow on chest X-ray. Chest CT showed a localized tumor on the mediastine. MRI showed a cyst. Under thoracoscopy the tumor was based on parietal pleura and movable in chest cavity. We concluded that back pain was caused by a stimulus of a nerve in parietal pleura. Pathological diagnosis was a bronchogenic cyst.     

A case of thymoma with thymic cyst]

A 43-year-old man was pointed out an abnormal shadow on chest X-ray film. Chest CT showed a solid mass and a cyst at anterior superior mediastinum. Operation revealed a capsulated thymoma and a multilocular thymic cyst. PTH and CA19-9 level in the cystic fluid was elevated. Histological examination demonstrated the clear separation of the mixed type thymoma and the thymic cyst. There were few reports for cases of thymoma with a thymic cyst.     

Right atrial blood cyst; report of a case

A 53-year-old female was admitted to our hospital for examination of an abnormal shadow on chest X-ray. Computed tomography (CT) revealed a large mass of 3 cm in diameter in the right atrium. The mass arose from the right atrial septum and was removed with the interatrial septum. Histological specimen showed a blood cyst contained serous effusion.     

Right thoracic kidney with simple renal cyst: report of a case

A case of right thoracic kidney with simple renal cyst is reported. A 67-year-old man was pointed out to have an abnormal shadow in the right lower lung field of chest X-ray film. He was asymptomatic. Laboratory test was normal. Computed tomography and excretory urography confirmed the right thoracic kidney with a simple cyst. Adrenal scintigraphy revealed a high ectopic adrenal gland with right thoracic kidney. Since he was asymptomatic, treatment was not required. High ectopic kidney is extremely rare and 74 cases have been reported in the domestic literature in Japan. Thoracic kidney should be considered as one of differential diagnoses of abnormal mediastinal shadow.     

Video-assisted thoracoscopical surgery for pericardial cyst: report of two cases]

Two cases of pericardial cyst are reported. Case 1: A 51-year-old man, was admitted to the hospital because of an abnormal shadow on a chest CT scan. We confirmed a cystic mediastinal tumor situated between the superior vena cava and azygos vein. The cystic tumor was excised with a video-assisted thoracoscopic surgical procedure. Histopathological examination revealed a mesothelial-lined structure. Patient 2, a 34-year-old woman was admitted to the hospital because of an abnormal shadow on a chest radiographic film. Chest CT scan showed a cystic mediastinal tumor. The cystic tumor was excised with a video-assisted thoracoscopic surgical procedure. Histopathological examination revealed a mesothelial-lined structure. We would recommend video-assisted thoracoscopic surgery which is of great value in the treatment of pericardial cyst.     

A case of mediastinal neurinoma originating from right intrathoracic vagal nerve

A 34-year-old woman was admitted with an abnormal shadow on a chest X-ray film. Under a preoperative diagnosis of benign bronchogenic cyst, operation was carried out and the tumor was found to be originating from the right main vagal nerve in the mid-superior mediastinum. The vagal nerve was transected to remove the tumor. Pathological diagnosis was a neurinoma. Postoperative complication was chylothorax which was successfully treated with thoracic drainage and intravenous hyperalimentation.     

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.     

Intrapericardial bronchogenic cyst--a report of two surgical cases

Two cases of intrapericardial bronchogenic cyst are reported. Case 1 was a 58-year-old man with a complaint of exertional dyspnea. A chest X-ray film showed a right hilar mass shadow. Echocardiographically the mass showed cystic pattern in the pericardium. A pulmonary angiogram revealed a mass displacing the right pulmonary artery superiolaterally and left atrium and pulmonary vein inferiorly. The preoperative diagnosis was intrapericardial cyst. Subtotal resection of intrapericardial cyst was performed via right thoracotomy. Histological diagnosis was bronchogenic cyst. The postoperative course was uneventful. Case 2 was a 41-year-old man. A displacement of the esophagus and duodenal ulcer was pointed out in the upper gastrointestinal series. A chest X-ray film showed a right hilar mass shadow. Since echocardiogram and pulmonary angiogram revealed similar findings to those in case 1, intrapericardial bronchogenic cyst was suspected preoperatively. Complete resection of the intrapericardial cyst was made via right thoracotomy. Histological diagnosis was bronchogenic cyst. The postoperative course was uneventful.     

Resection of giant mediastinal liposarcoma using the hemiclamshell incision

A 39-year-old woman who had experienced slight chest discomfort for a few months was referred to our hospital with an abnormal shadow on a regular checkup chest X-ray film. A computed tomography scan revealed a large well-defined mass in close relationship to the great vessels of the anterior mediastinum. Magnetic resonance imaging showed the anterior mediastinal mass, which was about 25 cm in diameter, expanding to the left pleural cavity with heterogeneous intensity. Because of the size and location of the mass, a combination of anterolateral thoracotomy and partial longitudinal median sternotomy-so-called hemiclamshell incision-was chosen, allowing excellent visualization and complete dissection of the giant tumor. The final histopathology of the resected specimen confirmed well-differentiated liposarcoma.     

Retroperitoneal cystadenoma containing elevated concentrations of CA125 and CA19-9 in the cyst fluid: a case report

A 67-year-old female presented with left abdominal distension. A huge retroperitoneal cystic mass, measuring over 20 cm in diameter, was found below the left kidney. The cyst was punctured percutaneously, and serous fluid was aspirated. It was noted that the concentrations of CA125 and CA19-9 in the fluid of the cyst were extremely elevated while those in the serum were normal. The cyst was resected easily without any adhesion. Microscopically, the cyst was lined with a mixture of ciliated and cuboidal serous cells and columnal mucinous cells. Immunohistochemical staining of the cyst wall proved positive for CA125 on serous cells, and for CA19-9 on mucinous cells.     

A case of mediastinal cystic lymphangioma--case reports and review of the literature in Japan

A 15-year-old woman was admitted to our hospital with complaints of left anterior chest pain and an abnormal shadow on her chest X-ray film. At the left thoracotomy, a large cyst (20.5 x 15 x 3 cm) was located in the left anterior mediastinum and contained translucent yellow fluid. Histological diagnosis was cystic lymphangioma. Mediastinal cystic lymphangioma is very rare among mediastinal tumors. Altogether 32 cases of mediastinal cystic lymphangioma including our case were collected from the Japanese literature and reviewed.     

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.     

Acute cardiac tamponade due to a bleeding pericardial cyst in a 3-year-old child

We report a case of a pericardial cyst complicated with acute cardiac tamponade in a 3-year-old child with no previous cardiac history who was transferred to our university hospital because of hemodynamic shock. A chest roentgenogram revealed marked cardiac enlargement, and transthoracic echocardiography showed massive pericardial effusion with a moving cystic structure. Percutaneous needle aspiration yielded bloody pericardial fluid. Emergency drainage of the pericardial effusion and resection of the cyst were performed through a median sternotomy. We found a blood-containing cyst that was attached to the right atrium near the sinus node and to the inferior wall of the pericardial cavity.     

Penetrating chest trauma in which thoracoscopy was helpful; report of a case

A 32-year-old builder suffered from a chest trauma in a construction area. A ratchet penetrated his right chest wall posterolaterally, and he was transferred to our hospital. A chest X-ray and a computed tomography (CT) revealed that the tip of the instrument remained in the thoracic cavity and there were no other obvious damages including pneumothorax, hemothorax, and liver damage. We thought the simple removal of the instrument from his body was dangerous so he was transferred to the operating room and his chest was opened under general anesthesia. However, it was difficult to confirm the inside of penetrating point from the thoracotomy wound; therefore we used a thoracoscope. The thoracoscopy disclosed a penetration in the lung and a contusion on the diaphragm. The application of thoracoscopy in the operation of thoracic trauma is very promising in exploration of the thoracic cavity, especially in the area which is out of vision from the open thoracotomy.     

Diagnosis of pericardial cysts: significance of cardiac magnetic resonance and literature review

Pericardial cysts are uncommon and caused by an incomplete coalescence of fetal lacunae forming the pericardium. The paper presents two cases of pericardial cyst and literature review. The first is a case of a female patient with progressive dispnoa and spherical mass located in the right cardiophrenic angle on a chest x-ray. A pericardial cyst with low signal intensity was noted on T1w, high signal intensity on T2w in TSE (turbo spin echo) sequence on magnetic resonance images (MRI) which was suggestive of serous content. The patient underwent pericardial puncture and was thereafter free of symptoms. Histologic study of the cyst confirmed hydatid cyst diagnosis. Another patient is with echocardiographic evidence of cystic formation which was confirmed on MRI, with high signal intensity on SSFP (steady state free precession) sequence. The cyst was without septa and without communication with pericardial space. Since there were no significant hemodynamic changes, the patient is on regular follow up.     

A case of intrathoracic perineurial cyst

A 67-year-old man was referred to our surgical clinic for evaluation of an abnormal shadow on the chest X-ray examination. CT scan and MRI revealed a tumor in the posterior mediastinum and destruction of the pedicle and intraspinal invagination by the tumor. The tumor in a paravertebral area are linked with a vertebral canal through a destructed intervertebral foramen. MRI showed that the tumor was a cyst which contained fluid. On thoracotomy a hen's egg sized cyst was found in the posterior mediastinum, the cyst was excised. Pathological diagnosis was a perineurial cyst. This case was clearly differentiated from an intrathoracic meningocele and a neurilemmoma microscopically. This case is the first intrathoracic perineurial cyst in Japan.     

A case of pulmonary dirofilariasis]

A 58-year-old man was admitted to our hospital for detailed examination of continuous cough. On a chest X-ray film, abnormal shadow was detected in the right lower lung field. Preoperative examination findings didn't lead to a definitive diagnosis. Under thoracoscopy partial resection of the lung was performed to rule out a malignant lesion. Intraoperative pathologic finding revealed a granulomatous lesion. And, final pathological diagnosis showed to be a pulmonary dirofilariasis. His postoperative course was not eventful. On 20 th day he discharged postoperatively. Now, under the Pet-boom the disease has been reported increasingly. But it is difficult to find the disease preoperatively. So, it is real to be operated for differentiate from a malignant lesion. Recently in many cases open lung biopsy, has been undergone with less invasive procedure such as thoracoscopy and VATS. It will be mainstream in future.     

A surgically treated case of capsulated thymoma with thymic cyst

A 56-year-old woman was pointed out an abnormal shadow on chest roentgenogram. Chest CT and MRI showed a solid mass with a cyst at right anterior mediastinum. Clinical diagnosis was thymoma with cyst, and surgical excision was performed. The histopathological examination of the resected specimen demonstrated that the epithelia of the cyst wall was single cuboidal or squamous cells and contained some foci of thymic tissue. The solid mass was capsulated and predominantly composed of lymphocytes. The pathological diagnosis was a thymoma (predominantly lymphocytic type) with thymic cyst. She is doing well for 10 years postoperatively.     

Chest wall lipoma mimicking a well differentiated liposarcoma; report of two cases

We experienced 2 cases of chest wall lipoma mimicking a well differentiated liposarcoma. The 1st case was a 60-year-old female. She admitted to our hospital with abnormal shadow detected by chest X-ray. Positron emission tomography combined with computed tomography (PET-CT) revealed fatty tumor penetrating left chest wall without significant accumulation of fluoro-2-deoxy-D-glucose (FDG). Resection of the tumor with partial resection of the 6th and 7th ribs with were performed, because the tumor was suspected to invade surrounding tissues by surgical findings. The other case was a 41-year-old male. He admitted to our hospital with abnormal shadow detected by chest X-ray. PET-CT revealed fatty tumor penetrating left chest wall and its standard uptake value (SUV) was 1.2. The tumor was resected with surrounding periosteum and intercostal muscle without thoracotomy. Both cases were diagnosed as lipoma by pathology.     

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.