Surgical resection of right atrial neurilemoma extending to pulmonary vein.

An asymptomatic cardiac neurilemoma was found in a 33-year-old woman. The tumor was on the anterior surface of the right atrium extending to the right upper pulmonary vein across the interatrial groove. The tumor was resected completely and right atrium, interatrial septum, left atrium and right superior pulmonary vein were reconstructed with cardiopulmonary bypass. The patient recovered uneventfully and had no recurrence 1 year after the operation. We reviewed ten reported cases of cardiac neurilemoma, including our patient.     

Four operative cases of lung carcinoma with intra-atrial extension via the pulmonary vein

We experienced four operative cases of lung carcinoma with intra-atrial extension via the pulmonary vein. In two cases, after assessment of the cardiac involvement, we performed extensive surgery under cardiopulmonary bypass. Their postoperative courses were uneventful, and their performance status was improved. However, seven months later one patient died of widespread metastases, while the other is alive but has recurrence. The other two patients underwent ordinary lobectomy because there were no abnormal findings in the hilar examination. However, the lumen of the resected pulmonary vein was filled with tumor tissue. One patient had massive embolism and died on the second postoperative day. The last case had residual tumor dislodging from the left atrium to the aorta. Though he was discharged without any complication, he developed multiple brain metastases 4 months after operation. We conclude that extensive surgery using cardiopulmonary bypass for lung cancer patients with such intracardiac involvement is effective for improvement of PS and reduces the risk of sudden death due to cardiac failure or emboli. Accurate diagnosis of intracardiac extension in these unusual cases is important.     

Resection of metastatic pulmonary lesion of osteosarcoma extended into the left atrium and ventricle via the pulmonary vein

A 35-year-old woman had underwent an amputation of the right hemimandibula for an osteosarcoma. Twenty months after the operation, she was admitted to our hospital with complaints of syncope. On chest computed tomography and echocardiography, an atrial tumor was disclosed, which extended from the lesion of the left pulmonary lower lobe. This tumor intravascularly developed through the left inferior pulmonary vein. The intracardiac tumor was resected through left atriotomy under cardiopulmonary bypass, and immediately after weaning of bypass left lower lobe was resected. On pathological study the tumor was diagnosed as metastasis of osteosarcoma. Despite postoperative chemotherapy including CDDP, she died of metastasis in pulmonary, adrenal gland and liver 12 months after the second operation.     

Successful treatment of intracardiac progression and metachronous multiple brain metastases from primary lung cancer

We report a rare case of squamous cell carcinoma of the lung extending into the left atrium via the pulmonary vein. The tumor tissue including the thrombus was resected enbloc under cardiopulmonary bypass. Despite adjuvant chemotherapy, multiple brain metastases developed, but they were eradicated by stereotactic radiosurgery. The patient is still diseasefree 48 months after the resection. This case serves to demonstrate the validity of multidisciplinary treatment for locally advanced lung cancer.     

Intracardiac renal cell carcinoma metastasis

Cardiac involvement by intravascular protruding renal cell carcinoma is a well-recognised phenomenon. It most commonly occurs through inferior vena cava extension. Here, we report a case of a lower lobar lung metastasis from renal cell carcinoma involving the left atrium via the inferior pulmonary vein in a patient presenting with von Hippel-Lindau disease. Complete surgical resection was achieved under cardiopulmonary bypass.     

Lung cancer with an extrapericardial single trunk as the left pulmonary vein; report of a case

A left lower lobectomy was successfully performed in a lung cancer patient with anatomical variation in which the left superior and inferior pulmonary veins were connected to the left atrium after forming an extrapericardial single trunk. This variation is surgically important because ligation and division of the left inferior pulmonary vein may result in blockage of upper lobe vein drainage at the time of a left lower lobectomy. The ligation of the pulmonary vein leads to severe lung edema, which may cause infection, respiratory distress, or postoperative complications that could be life-threatening. Surgeons must always pay attention to this variation when performing a left lower lobectomy.     

Ex-situ-Manschettenresektion mit Autotransplantation des linken Lungenunterlappens nach erweiterter Pneumonektomie

A 69-year-old patient with reduced pulmonary function was diagnosed as suffering from non-small cell lung cancer of the left lung invading the main bronchus, pulmonary artery and left atrium. Staging examinations were negative. Using cardiopulmonary bypass, an extended pneumonectomy with partial resection of the left atrium was performed. The cardiac defect was closed with a pericardial patch. The lower lobe was divided ex situ from the upper lobe and reimplanted with anastomosis of the lower pulmonary vein to the left auricle. After a totally uneventful course the patient is in good condition and free of tumor recurrence 2.5 years postoperatively.     

Bilateral Trans-Septal Approach to Right Lung Cancer Invading the Left Atrium

We describe a 69-year-old woman with primary lung cancer in the right lower lobe invasive to the left atrium (LA) via the pulmonary vein (PV). The tumor in the LA measured 30 × 26 mm, and to avoid critical embolism preoperative induction therapy was not performed. The patient underwent right thoracotomy under cardiopulmonary bypass (CPB), and the atrial septum was incised via the right atrium. The tumor was placed out of the LA, followed by lobectomy. For right lung tumors invading the LA, the bilateral trans-septal approach is useful for confirming the surgical margin.     

Endobronchial metastasis from a primary uterine osteosarcoma in a patient with multiple myeloma: Report of a case

We present herein the case of a 75-year-old woman with multiple myeloma who underwent a left lower lobectomy for endobronchial metastasis from an uterine osteosarcoma. She had initially been admitted to our hospital for chemotherapy more than 1 year earlier, soon after which a primary uterine osteosarcoma was discovered and a total abdominal hysterectomy and bilateral salpingo-oophorectomy performed. One year after the operation, the patient developed hemoptysis. A flexible bronchofiberscopy demonstrated a polypoid mass obstructing the left basal bronchus, and computed tomographic scans showed three pulmonary nodules. Surgery was performed to control the hemoptysis. At thoracotomy, two metastatic nodules were identified in the left lower lobe, and the endobronchial extension of the tumor was resected en bloc with the left lower lobe. The tumor was diagnosed as lung metastasis from the uterine osteosarcoma. Although further lung tumors have recently appeared, the patient has remained well for the 3 years since her last operation without any hemoptysis.     

Anomalous V2 of the left pulmonary vein detected using three-dimensional computed tomography in a patient with lung cancer: A case report

We report one of the rare anatomical variations of the pulmonary vein wherein the left V2 drained into the inferior pulmonary vein. A 63-year-old man was referred to our hospital because of an abnormal shadow in the left lower lung field that was noted on chest X-ray. Computed tomography (CT) revealed a tumor in the left lower lobe. A biopsied tumor specimen was diagnosed as an adenocarcinoma, and thus, left lower lobectomy was performed. Preoperative three-dimensional CT revealed that an anomalous V2 of the left lung drained from the superior segment into the inferior pulmonary vein. This variation type was confirmed during thoracoscopic left lower lobectomy. We were able to perform left lower lobectomy with the preservation of the anomalous V2. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. It is important to identify anatomical variations of the pulmonary vein and reliably preserve and process the affected area to prevent postoperative complications.     

Right hemi-reconstruction of the left atrium using two equine pericardial patches for recurrent malignant fibrous histiocytoma: Report of a case

We report a case of recurrent malignant fibrous histiocytoma (MFH) in the left atrium, treated by removal of the tumor and the right half of the left atrium, which was reconstructed with two equine pericardial patches. Postoperative echocardiography showed patent right pulmonary veins and a properly shaped left atrium. The patient survived for 3 years after the operation with no cardiac symptoms.     

Thymoma which is detected with a cough derived from pulmonary invasion; report of a case

A 83-year-old female was referred to our hospital for investigation of a persistent cough. A chest X-ray showed enlargement of the mediastinum. Computed tomography of the chest showed an anterior mediastinal mass with a maximal diameter of 6.5 cm, which had invasion to the lung. The patient underwent thymothymectomy combined resections of the lung, pericardium, and left innominate vein through a median sternotomy. Histological examination of the resected tumor revealed a World Health Organization (WHO) classification type B3 thymoma with infiltration into the lung. There were no infiltrations of the tumor into the pericardium and the innominate vein. A persistent cough disappeared after surgery. No adjuvant chemotherapy was performed. She is still free from disease with a follow-up period of 4 months. We report a rare case of thymoma detected with a persistent cough derived from pulmonary invasion.     

An atypically localized atrial myxoma: a case report

Atypical cardiac myxomas are rare occurrences and may present with a variety of clinical manifestations depending on the location and morphology. A 46-year-old woman had a 4 x 3 x 2-cm myxoma originating from the superior wall of the left atrium, found by echocardiography and multislice tomography. The tumor was successfully treated by surgical excision. The resected tumor was a well-defined encapsulated mass with a narrow-base stalk originating from the right wall of the left atrium in between the right upper and lower pulmonary vein. The patient recovered without complication and was discharged 6 days after the operation. At 1-year follow-up, echocardiography revealed normal cardiac function without reccurence in terms of mass. Although up to 80% of myxomas are localized in the left atrium, of which 75% involve in the interatrial septum, it should not be forgotten that myxomas can appear in an atypical localization, as occurred in our case.     

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.     

Bilateral partial anomalous pulmonary venous connection; report of a case

We have experienced a case of bilateral partial anomalous pulmonary venous connection with a fossa ovalis type of atrial septal defect and pulmonary stenosis. The right upper pulmonary vein returned to the superior vena cava and the left upper pulmonary vein returned to the left innominate vein via the vertical vein. The atrial septal defect was enlarged and the right upper pulmonary vein was baffled into the left atrium with an equine pericardial patch. The left upper pulmonary vein was divided and anastomosed to the left atrial appendage. Pulmonary commissurotomy was also done for concomitant pulmonary stenosis. Postoperative course of the patient was excellent with constantly normal sinus rhythm. Angiography 2 weeks after operation showed no evidence of pulmonary venous obstructions on both sides.     

Malignant fibrous histiocytoma of the heart]

A 59-year-old woman was referred to our hospital by a local cardiologist, with unknown cause of congestive heart failure and respiratory failure. No significant heart murmur was heard and a cardioechogram from the anterior chest was insufficient for diagnosis. On the night of admission, cardio-respiratory shock was found, and Swan-Gantz catheter data showed severe pulmonary hypertension. Transesophageal echo-cardiography (TEE) revealed a left atrial tumor, with wide neck anchored onto the posterior wall of the left atrium, and which was floating into the left ventricle during the diastolic phase. An emergency operation was performed and the tumor, (80 by 50 by 48 mm) was resected. The patient recovered well in the postoperation period. However the residual tumor continued to grow gradually in the pericardial cavity and the patient died 3 months after the operation. Primary MFH of the heart is rare and 29 cases have been reported. The prognosis of MFH is poor despite surgery. Whenever a left atrial tumor with a wide neck is attached to the posterior wall, it must be considered to be possibly malignant and surgical resection is recommended.     

A thoracoscopic resection of pulmonary metastasis from breast cancer: a case report with a 27-year disease-free interval

A 70-year-old woman, who had undergone a right radical mastectomy for breast cancer 27 years previously, was found to have a tumor measuring 15 mm in diameter between the S5 area and the S8 area of the left lung. We suspected it to be either metastatic or primary lung cancer based on preoperatively any conclusive diagnosis. We thus performed a thoracoscopic partial lung resection and pericardial resection. The pathological diagnosis of the resected specimen was pulmonary metastasis from the previous breast cancer, since the pathological findings of the lung lesion were closely similar to those of the previous breast lesion. Using immunohistochemical methods, the tumor cells show positive staining for anti-estrogen receptor antibody. In lung tumor cases in which the patient has undergone a breast cancer resection, even more than 20 years previously, surgeons must not rule out the possibility of recurrence. Thoracoscopic surgery is considered to be most effective method for both making a definitive diagnosis and for performing curative treatment.     

Pulmonary sequestration complicated by anomalies of pulmonary venous return

Five anomalies of pulmonary venous drainage were seen among 12 children operated for lung sequestration. In two children, venous drainage from the sequestrated lobe and the rest of the right lung was via a single channel into the inferior vena cava ("scimitar syndrome"). In one of these children, the sequestrated lobe was resected and repair of the scimitar syndrome was delayed; in the second patient, the anomalous pulmonary venous drainage was not recognized preoperatively and the vein was ligated, resulting in acute hemorrhagic infarction of the right lung and death of the patient. Three patients had less severe anomalies of pulmonary venous drainage. We recommend very careful evaluation of patients with lung sequestration with special reference to pulmonary venous drainage.     

Malignant fibrous histiocytoma of the heart--a case report and review of the literature]

Malignant fibrous histiocytoma (MFH) has been rarely reported as a primary tumor of the heart. We present a case of a primary intracardiac MFH and review the 28 previous reports of this rare cardiac tumor. A 48-year-old woman underwent an operation for congestive heart failure (CHF) due to a left atrial tumor. A large multinodular tumor attached to the posterior wall of the left atrium and extended into the mitral annulus and the posterior leaflet of the mitral valve. The tumor was resected incompletely and mitral valve replacement was performed. Pathological diagnosis was MFH. The patient did well in the postoperative period, but she again presented with symptoms of CHF four months later. Chest CT and two-dimensional echocardiogram demonstrated a recurrent tumor of the left atrium. Since the tumor grew rapidly despite chemotherapy, a reoperation was performed to remove it. Nevertheless, as the tumor was found to have extended into the pericardial cavity and posterior mediastinum, only partial resection was possible. After a protracted operation, the heart failed to sustain the circulation and the patient died. The prognosis of intracardiac MFH was poor in spite of surgery, radiation and/or chemotherapy. However, repeated surgical treatments can relieve symptoms of CHF and may prolong the life of patients.     

A case of successful resection of pulmonary arteriovenous fistula with a high shunt ratio

We report on a 25-year-old cyanotic man who was diagnosed as having a pulmonary arteriovenous fistula. His chief complaint had been shortness of breath since childhood. Polycythemia (Hb 21.4 g/dl) was detected during a health checkup at his company. A chest X-ray showed an abnormal mass in the left lung. Blood gas analysis showed severe hypoxia with PaO₂ of 38.6 mmHg at room air. Angio-CT showed a large aneurysmal lesion at S6 of the left lung with a large feeding artery and vein. Oxygen saturation was 75.2% in the radial artery and 62.5% in the right atrium. The right-to-left shunt ratio was therefore calculated as 62%. The aneurysmal lesion was resected by segmentectomy of the left S6 following division of A6 and V6. After a successful operation, the patient no longer had shortness of breath or cyanosis and blood gas analysis showed PaO₂ as 84.3 mmHg at room air. Pulmonary angiography showed no residual shunt lesion.