Intrapulmonary hematoma surrounding the stapled line after video-assisted thoracoscopic bullectomy for spontaneous pneumothorax]

A 52-year-old man presented at our hospital with hemoptysis three months after undergoing a video-assisted thoracoscopic bullectomy for spontaneous pneumothorax. A chest X-ray showed a localized infiltrative shadow in the right upper lobe of the lung. The chest CT findings revealed a mass-like lesion surrounding the staple which had been used during the bullectomy. He therefore underwent a pulmonary resection including the lesion due to the continued hemoptysis that did not improve even after treatment by hemostatic agents and bronchial arterial embolization. The resected specimen revealed an intrapulmonary hematoma with severe inflammation. The late onset hematoma which was induced by the stapler may thus be a rare complication in video-assisted thoracoscopic surgery.     

A case of congenital cystic adenomatoid malformation of the lung in a 4-year-old child

A case of congenital cystic adenomatoid malformation (CCAM) of the lung is reported. A 3-year-old boy was admitted for elevation of infiltrative shadow in the right lower lung field on a chest X-ray. The clinical diagnosis was emphysematous bullae with inflammation. After 6 months, he had recurrent infected bullae, and was admitted. He received chemotherapy with antibiotics prior to the operation. Right lower lobectomy was performed on February 2, 1998. The resected lung was composed of multiple cysts with thin wall measuring 10-60 mm in diameter. The histological examination of specimen revealed CCAM (Stocker type I), which is rare in this age. The patient has been well for 16 months postoperatively.     

Mycobacterium avium complex disease after conservative therapy for 3 years; report of a case

A 62-year old woman admitted to our hospital because of an abnormal shadow on chest X-ray. Chest X-ray and computed tomography (CT) scan revealed a 2 cm nodular shadow with cavity in the right upper lobe. Bronchofiberscopy was performed, and Mycobacterium avium complex was demonstrated bacteriologically. She had been followed-up for 3 years with chemotherapy, however slow but progressive enlargement of the lesion was noted on chest X-ray. Finally she reffered to our department for surgical treatment, and right upper lobectomy was performed. Ten months after operation, there is no sign of recurrence.     

Primary bronchopulmonary fibrosarcoma: Report of a case

We herein report a case of primary bronchopulmonary fibrosarcoma in a 70-year-old man. The patient was referred to our hospital for investigation of hemosputum and an abnormal shadow. On admission, chest radiograph and computed tomography scan showed a mass lesion in right S³ and an infiltrative shadow in the right upper lobe. Transbronchial biopsy specimens showed findings of malignancy, and adenocarcinoma was suspected. A right pneumonectomy was performed, and pathologic examination confirmed a diagnosis of fibrosarcoma. The patient had an uneventful recovery and no sign of recurrence has been found in the year since his operation, although strict follow-up is essential.     

Treatment of pericardial cyst under thoracoscopy]

Thoracoscopic therapy was carried out on two cases of pericardial cyst. The first patient was a 24-year-old male. An abnormal shadow on a chest X-ray was pointed out at a regular checkup. Thoracoscopy was carried out under the local anesthesia and a thin-walled cyst was discovered. The cyst was punctured and serous fluid was aspirated. Then, several biopsy specimens were obtained from the cyst wall, a pathological diagnosis of the cyst was made as a pericardial cyst. One year after the thoracoscopy, no abnormal shadow is observed on chest X-ray. The second patient was a 26-year-old male. It was also discovered that he had an abnormal shadow on a chest X-ray at a regular medical checkup. Since a solid mass couldn't be completely denied, thoracoscopy was carried out in preparing for thoracotomy under the general anesthesia. The cyst observed between SVC and the azygos vein, and serous fluid was aspirated form the cyst. Following this, the cyst wall was biopsied and opened. Since no cases of malignant pericardial cysts have been reported, an operation is not usually required for these patients. We suggest that thoracoscopy is very useful tool for the final diagnosis and therapy of pericardial cyst because this method is easily carried out under local anesthesia.     

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.     

A case of pulmonary arteriovenous fistula treated by subsegmentectomy with CUSA

A 35-year-old female who had no symptom was admitted to our hospital because of an abnormal shadow in the middle area of the right lung in a chest X-ray film. The chest tomography, CT and the angiography revealed a pulmonary arteriovenous fistula. It located in the right upper lobe, and was successfully resected by subsegmentectomy of S3b using CUSA. The results indicated that the CUSA was useful in the surgical treatment of the pulmonary arteriovenous fistula which had many vascular anastomoses.     

Two cases of supposed metastasizing leiomyosarcoma of the uterus

Case 1. A 57-year-old female had hysterectomy 10 years ago because of leiomyoma uteri. She was recently found to have a clear-cut round mass shadow in the right middle lung field on her chest X-ray film 3. The mass was resected and microscopically diagnosed as metastatic leiomyosarcoma. Re-examination of the pathological specimen of the uterine tumor resected 10 years ago revealed 5-9 mitosis per 10 high-powered fields (/10 HPF). Case 2. A 54-year-old female who had undergone hysterectomy for myoma uteri 9 years previously was found to have a well-defined oval shadow in the left lower lung field which was resected and pathologically diagnosed as metastatic leiomyosarcoma. Her uterus lesion microscopically revealed 1-2 mitosis/10 HPF. The relationship between metastatic leiomyosarcoma of the lung and mitotic activity of leiomyoma uteri was discussed.     

A case of pryce type I intrapulmonary sequestration

A twenty-year-old asymptomatic man hospitalized because of a vascular murmur and abnormal shadow in the left lower lung on X-ray film. An aortogram revealed an abnormal artery arising from the descending thoracic aorta and supplying the left basal segment, which had no other pulmonary arteries. Although lung ventilation scintigraphy demonstrated reduced ventilation to the left lower lobe, bronchogram showed an almost normal bronchial tree except that peripheral branches were slightly thin. A clinical diagnosis of Pryce type I intrapulmonary sequestration was made, and left lower lobectomy was performed successfully. We have analyzed 31 cases of Pryce type I intrapulmonary sequestration in Japan. A vascular murmur is often heard, and a chest X-ray usually shows either a mass shadow or increased vascular markings. In most of those cases, an abnormal artery arises from the descending thoracic aorta and it supplies the left basal segment. Because this type of sequestration causes hemoptysis and infections, surgical intervention is indicated.     

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.     

Pulmonary artery aneurysm-like associated with pulmonary stenosis

A 55-year old man had complained shortness of breathing and an abnormal shadow at left hilus region had been pointed out on the chest X-ray film. Right heart catheterization and right ventriculography revealed pulmonary valve stenosis with pulmonary artery aneurysm-like. Utilizing cardiopulmonary bypass, aneurysmorrhaphy and valvotomy was performed. Postoperative course was good and he was discharged on the 29th postoperative day. It is considered that mild post-stenotic dilatation of pulmonary trunk due to pulmonary valvular stenosis might develop into the aneurysmal change because of some congenital structural deficiency in the pulmonary arterial wall.     

Usefulness of the eradication of Helicobacter pylori for the patient with idiopathic thrombocytopenic purpura and lung cancer: report of a case

A 61-year-old female was admitted because of an abnormal lung shadow on chest X-ray. She had suffered from idiopathic thrombocytopenic purpura (ITP) for more than 7 years. Computed tomography (CT) revealed that an irregular shadow, about 2 cm in diameter, was located in the upper lobe of the right lung. After intravenous immunogrobulin injections for 5 days, a hematology test indicated increased platelet counts and we performed thoracoscopic surgery successfully without blood transfusions. However, 4 months after surgery, a hematology test indicated decreased platelet counts again. Thirteen months after the operation, gastrointestinal fiberscopic examination showed Helicobacter pylori infection. After the urea breath test, eradication therapy let to a recovery in platelet counts.     

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.     

A case report of subdiaphragmatic pulmonary sequestration

A 32-year-old man with extralobar pulmonary sequestration under diaphragm is reported. The patient was admitted because of abnormal shadow on chest X-ray film without any complaints. Chest roentgenogram showed a homogenous density at the left cardiophrenic angle. Aortogram demonstrated an abnormal artery arising from the abdominal aorta to left subphrenic mass shadow. On laparotomy a large cystic mass connected with diaphragm was found behind the stomach and removed successfully. The postoperative course was uneventful. The histological diagnosis was subphrenic pulmonary sequestration. The frequency, localisation, pathogenesis of pulmonary sequestration are discussed.     

Pleomorphic adenoma of the lung; report of a case

A 67-year-old woman was admitted because of an abnormal shadow on the chest X-ray film. Chest computed tomography (CT) film revealed a peripheral mass in the middle lower lobe of the lung. We performed open lung biopsy and diagnosed as a benign epithelial adenoma but not ruled out adenocarcinoma completely by intraoperative examination of frozen sections. We operated right middle lobectomy and mediastinal lymph nodes dissections. Histological examination confirmed pleomorphic adenoma. We examined salivary glands, but didn't find the focus of that. The patient had been well for three years postoperatively.     

A case report of neurinoma originating from the recurrent nerve]

A 55-year-old man was admitted to hospital because of an abnormal shadow on his chest X-ray film. On examination, the patient appeared healthy. CT scan, magnetic resonance imaging, and ultrasonography showed evidence of a tumor. At operation, a tumor was found originating from the left recurrent nerve, and it was removed together with the vagus nerve. The patient had a favorable postoperative course except for hoarseness, and was discharged on the 31st postoperative day. Mediastinal neurinoma originating from the recurrent nerve is rare, and only 20 cases have been reported in Japan.     

Combined large cell neuroendocrine carcinoma and squamous cell carcinoma of the lung; report of a case

An 80-year-old man was admitted to our hospital because a routine chest X-ray had revealed a nodular shadow in the right lower lung field. Transbronchial lung biopsy (TBLB) failed to give at definitive diagnosis, therefore open lung biopsy was performed because of suspected lung cancer. Rapid intraoperative pathological examination diagnosed the tumor as large cell carcinoma. However, bloody pleural effusion was classified as class V. It was judged difficult to perform a curative operation, so the operation was interrupted. Pathological diagnosis was combined large cell neuroendocrine carcinoma and squamous cell carcinoma. Pleurodesis was done, and the patient is under observation at 7 months after the operation.     

Pleomorphic adenoma of the lung

A 41 year-old male was admitted to our hospital, because a suspicious shadow in the right lower lung field was on X-ray. Investigations could not confirm cancer but were highly suggestive of it. Finally, right lower lobectomy was performed, and the histopathological finding of the tumor resected were a mixture of epithelial components in myxomatous tissue, so a diagnosis of pleomorphic adenoma of the lung was made.     

Cavitating pleomorphic carcinoma of the lung; report of a case

We report a case of a previously healthy 76-year-old male with cavitating pleomorphic carcinoma of the lung. He was admitted because of an abnormal lung shadow on chest X-ray. Computed tomography (CT) showed a well-demarcated nodular shadow within thin-walled cavity in the right upper lobe. Because the lesion was revealed as adenocarcinoma by transbronchial lung biopsy, right upper lobectomy was performed. By histopathologic examination of the resected specimen, the nodule contained a component of spindle cell features and the cavity wall was composed of adenocarcinoma. The final diagnosis was pleomorphic carcinoma. Postoperative course has been uneventful for 12 months after surgery.     

A case of primary lung adenocarcinoma with diffuse calcification in the tumor by psamoma bodies

A 78-year-old asymptomatic woman was referred to our department for the treatment of a right lung tumor. The patient had been suffering from rheumatoid arthritis and followed up in outpatient clinic. On March 6, 1995, abnormal shadow in the right upper lobe was pointed out by routine chest X-ray. Chest CT revealed calcification in the shadow, and benign lesion, such as old pulmonary tuberculosis, was suspected. During follow-up, the size of the shadow and calcification area in the shadow gradually increased. Malignancy was suspected based on the increasing size of the tumor. On July 12, 2000, video-assisted right upper lobectomy with hilar and mediastinal lymph node sampling was performed. Pathological examination revealed that the tumor was primary lung adenocarcinoma containing psamoma bodies in the tumor.