Benign metastasizing leiomyoma of the lung. Report of a case]

Benign metastasizing leiomyoma (BML) is the term used to describe multiple benign pulmonary leiomyomatous lesions occurring in patients with a previous history of uterine leiomyoma. On the other hand, pulmonary fibroleiomyomatous hamartoma (FLH) is also multiple nodules and the discrimination of the nodules between BML and FLH is not determined. We report the case of 36-year-old woman who had a previous history of uterine leiomyoma. The woman was referred to our hospital for evaluation of asymptomatic bilateral nodules in chest roentgenogram examination. A chest X-ray showed multiple nodules in bilateral lung. Chest computed tomography (CT) scan showed round nodules well-defined margins in bilateral lung. Thoracoscopic partial resection of the lung was performed. Pathological examination revealed that the tumor composed of spindle-shaped smooth muscle cells and its characteristics were remarkably similar to those of the previously resected uterine leiomyoma. Therefore, these lung tumors could be considered to be lung metastases from a uterine leiomyoma (benign metastasizing leiomyoma).     

Multiple pulmonary metastasis from histologically benign giant cell tumor of the right radial olecranon]

An unusual case of a benign giant cell tumor of bone with pulmonary metastasis is reported. A 23-year-old man had a painful tumor in the right radial olecranon that proved to be a histologically benign giant cell tumor. Curettage and bone-grafting were performed, but the tumor recurred twice, 8 months and 20 months after initial treatment. Histological examination of biopsy materials from the recurring tumor showed typical benign giant cell tumors. Five years later, wedge resections were performed for bilateral pulmonary nodules, which had been detected by chance. The pulmonary nodules turned out to be histologically similar to the primary tumor of the olecranon. Almost 7 years later, he was asymptomatic and the chest radiograph was clear, and there was no local recurrence of the lesion.     

Pulmonary benign metastasizing leiomyoma: a case report and literature review

Benign metastasizing leiomyoma (BML) is a rare condition that occurs in all age groups and that is particularly prevalent among women of late childbearing age. All patients have a history of uterine leiomyoma and/or myomectomy, often associated with distant metastases from the uterus, which commonly occurs in the lung. We report the case of a 32-year-old young woman suffering from chest stuffiness, labored respiration and weakness after a myomectomy performed one month earlier. The chest CT showed a diffuse miliary shadow in both sides of her lungs, but serum tumor markers such as CA125, CA199, carcinoembryonic antigen (CEA), neuron specific enolase (NSE), and CYFRA21-1 were normal. The patient underwent a lung biopsy by thoracoscopic surgery after four weeks of anti-TB treatment; there were no significant changes in the chest CT. H&E staining showed that the tumor cells had characteristics of smooth muscle cell differentiation. Immunohistochemical staining showed a low tumor cell proliferation index, which indicated that the likelihood of a malignancy was not high. There was no expression of CD10, indicating a diagnosis of pulmonary benign metastasizing leiomyoma (PBML). Smooth muscle actin (SMA) and desmin as specific markers of smooth muscle and the estrogen receptor (ER) and progesterone receptor (PR) were all strongly positive, which is characteristic of PBML. The patient was given the anti-estrogen tamoxifen for 3 months. With no radiological evidence of disease development and further distant metastasis, the patient will continue to be followed.     

A case of primary lung cancer in a young female with tongue cancer]

We describe a case of lung tumor in a 33-year-old woman with tongue cancer. She had noticed a painful sensation in her tongue in April 2000. The results of a physical examination showed a 22 x 11 mm ulcerated lesion on the right side of her tongue. A biopsy specimen showed a moderately differentiated squamous cell carcinoma. A preoperative chest radiograph showed no evidence of pulmonary metastasis. No neck lymphadenopathy was found. The tongue cancer was resected in September 2000, and the pathological stage was T2 N0 M0. A solitary pulmonary lesion appeared 8 months after the surgery. A Histological examination of a transbronchial lung biopsy specimen showed a moderately differentiated squamous cell carcinoma. It was difficult to distinguish histopathologically or immunohistochemically between a second primary tumor and a metastasis, but the pulmonary lesion was considered to be a second primary tumor on the basis of a single endobronchial lesion that appeared after the T2 tongue cancer with no regional recurrence or cervical lymphadenopathy. Treatment with chemotherapy and irradiation was not effective and the patient died 3 months after the diagnosis of lung cancer.     

Primary cardiac sarcoma: two case reports

Two case reports of primary cardiac sarcoma, which is uncommon, are presented. The first case, a 38-year-old male, complained of chest tightness. Chest roentgenograms showed enlargement of the cardiac shadow and left pleural effusion. Transthoracic echocardiography and chest magnetic resonance imaging showed a tumor in the right atrium, and pericardial effusion. The tumor involved the right atrial wall and interatrial septum, and was partially resected. Pathohistological examination revealed angiosarcoma. He died 1 month later. The second case, a 19-year-old male complained of dyspnea and orthopnea. Chest roentgenograms showed pulmonary congestion. Transthoracic echocardiography showed a large mobile mass in the left atrium. An emergency operation was performed and the tumor was totally resected. Pathohistological examination demonstrated leiomyosarcoma. The postoperative course was uneventful, but the tumor rapidly recurred. Second and third operations were performed at intervals of 2 months. After the third operation, he was treated with radiotherapy. Local recurrence was not found but multiple distant metastases were found 2 months after completion of radiation therapy.     

Complete disappearance of pulmonary metastases in a case of hepatocellular carcinoma treated with docetaxel-based systemic chemotherapy

A case of the complete shrinkage of pulmonary metastases from multiple hepatocellular carcinomas (HCC) after administration of docetaxel, cisplatin and enteric-coated tegafur/uracil is reported. A 54-year-old Japanese man was diagnosed with recurrent multiple HCC associated with pulmonary metastases and compensated liver cirrhosis. Docetaxel, cisplatin and enteric-coated tegafur/uracil were given to this patient. After 2 months of treatment, there was a decrease in tumor markers and a shrinkage of the pulmonary metastases. Image analyses such as chest X-rays and chest computed tomography scans showed a disappearance of the pulmonary metastases, although the multiple HCC did not disappear completely. This was evaluated as a complete remission of metastatic lesions or a partial remission of primary lesions according to the World Health Organization criteria. No recurrence of pulmonary metastasis was seen for 10 months. This combination therapy was well-tolerated for lung cancer and could represent an effective treatment for pulmonary metastases from HCC.     

原发性心脏恶性肿瘤的诊断与外科治疗经验

目的总结原发性心脏恶性肿瘤的诊断和外科治疗经验。方法2003年1月至2007年12月手术治疗4例原发性心脏恶性肿瘤,其中男1例,女3例,年龄26~43岁,平均35岁,本组除1例右心房肿瘤广泛侵犯右房室环及心包仅做活检外,其余3例均在全麻低温体外循环辅助下行肿瘤切除术,根据肿瘤的部位及侵润程度,完整切除2例,姑息切除1例,同期行室间隔修补、肺动脉成形1例,二尖瓣置换1例,三尖瓣成形1例。结果全组无围术期死亡。单纯探查活检术的患者2个月后死于心力衰竭;1例右心室梭形细胞肉瘤术后辅助放、化疗,术后18个月肿瘤复发死于右心衰竭;1例左心房恶性间皮瘤手术后3个月死于双肺广泛转移;1例左心房梭形细胞肉瘤术后随访5个月无肿瘤复发。结论原发心脏恶性肿瘤预后欠佳,早期诊断,及时手术治疗辅以综合治疗可望改善预后。     

甲磺酸伊马替尼致间质性肺炎1例并文献复习

目的 提高对甲磺酸伊马替尼所致间质性肺炎的认识,做到早期诊断和治疗,改善患者预后.方法 对北京大学首钢医院呼吸内科诊治的1例甲磺酸伊马替尼致间质性肺炎患者的临床资料进行回顾性分析,并进行相关文献复习.结果 患者女性,小肠间质瘤术后服用甲磺酸伊马替尼3个半月后出现水肿、呼吸困难,入院后胸部CT提示双肺弥漫分布的斑片影,BALF显示细胞总数升高(0.54×109/L),其中淋巴细胞56％.除外感染、自身免疫性疾病和其他药物因素,诊断甲磺酸伊马替尼导致的间质性肺炎,停止服用伊马替尼3周后患者呼吸困难无改善,后加用糖皮质激素治疗,激素治疗约2周后患者呼吸困难明显减轻,胸部CT双肺斑片影较前部分吸收,激素治疗4个月后复查胸部CT病变较前明显吸收,但遗留肺间质纤维化改变,停用激素治疗.随访患者未再服用甲磺酸伊马替尼,2年及5年后胸部CT较前无明显变化,3年后患者因小肠间质瘤复发再次手术切除.结论 服用甲磺酸伊马替尼后出现呼吸困难症状应考虑间质性肺炎可能,早期诊断、停药和应用糖皮质激素治疗可获得显著效果,停药后应长期随访患者基础疾病及肺部情况.通过这此例报道并进行文献复习有助于提高对甲磺酸伊马替尼所致间质性肺炎的认识.     

A case report of large cell lung cancer detected in the course of antituberculous therapy after a giant bullectomy

A case of a 60-year-old who male developed lung cancer after surgical resection of a emphysematous giant bulla. At first, he showed a emphysematous giant bulla associated with infected bulla in the right lung on the chest roentgenograph. After a giant bullectomy the resected specimen, suggested possible pulmonary tuberculosis. Thereafter, he was followed for one year with antituberculous therapy. Nevertheless, the chest roentgenograph taken one year after surgery, showed a new tumor density (1.5 x 2.0 cm) in the right lung. Due to the rapid growth of the lung tumor, right upper lobectomy was performed. The histological diagnosis was a large cell lung cancer (giant cell type). The postoperative staging of the tumor proved to be T2N0M0. He was treated with systemic chemotherapy of CDDP 120 mg, VDS 4.5 mg, and MMC 12 mg. Unfortunately, he died of cancer recurrence 5 months after lobectomy. Clinical evaluation of the emphysematous giant bulla associated with lung cancer was performed.     

A case of obstructive ventilatory disturbance caused by bronchial wall granulation due to a fish bone]

A 62-year-old man was admitted to Kawasaki Medical School Kawasaki Hospital after suffering from wheezing for one year. His chest X-ray film showed no significant findings in the lung fields and mediastinum. A chest CT film showed a small protrusion at the posterior wall of the right main bronchus. Bronchofiberscopy disclosed a polypoid tumor with a smooth surface in the right main bronchus, confirming the finding of the chest CT, and a restiform eminence at the truncus intermedius. The restiform eminence was revealed to be a fish bone after removal from the bronchus using the forceps of a bronchofiberscope. Histological examination of a bronchoscopic biopsy specimen from the tumor of the right main bronchus showed inflammatory granulation tissue. We confirm subsequently questioned the patient who revealed that he had aspirated another fish bone two months earlier, and we presumed that the tumor of the right main bronchus might be granulation tissue secondary to the impaction of a fish bone. The patient was not aware that he had aspirated a foreign body, but it was presumed that he had aspirated the fish bone one year earlier, coinciding with the onset of wheezing. Immediately after removal, his wheezing disappeared. Comparison of the results of pulmonary function tests after removal with those before showed improvement of V25/predicted V25 ratio from 24% to 72%, and improvement of V50/V25 ratio from 3.7 to 2.4. This is considered to be a rare case of bronchial granulation due to a foreign body, which was recognized as a small polypoid tumor by chest CT.     

Primary malignant lymphoma of uterine corpus: case report and review of the literature

We describe a patient presenting with postmenopausal vaginal bleeding and a uterine mass subjected to endometrial biopsy that showed a high-grade non-Hodgkin's lymphoma, consistent with a diffuse large B-cell lymphoma. Staging computed tomography (CT) scans of the chest, abdomen, and pelvis revealed three lung nodules in addition to the uterine mass. Fine needle aspirate of one lung lesion showed lymphomatous involvement. She was treated with intensive chemotherapy alone and has remained in complete remission 21 months after diagnosis. The literature on primary lymphoma of the uterine corpus is reviewed.     

A case of pulmonary metastasis from carcinosarcoma of uterus with subcutaneous implantation of tumor cells along the needle tract after percutaneous needle biopsy of lung]

A 68-year-old female who had undergone total hysterectomy for carcinosarcoma five months previously was noted to have a solitary nodular shadow in the right lung on chest X-ray. Percutaneous needle biopsy of the lung was performed via the right anterior chest wall, and the histologic findings showed metastasis from carcinosarcoma of uterus. Two months after needle biopsy, a chest wall mass appeared of the site of puncture of the lung needle biopsy. The mass was resected to relieve the chest wall pain and the specimen showed carcinosarcoma of uterus histologically. We consider that tumor cells were implanted to the chest wall along the needle tract after percutaneous needle biopsy of the lung. The postoperative chest computed tomogram showed the route of tumor implantation from the metastasis of right lung into the right chest wall. Dissemination and chest wall implantation of malignant cells after percutaneous lung needle biopsy have been rarely reported. However there are no reports of tumor implantation of sarcoma. The possibility of implantation of tumor cells along the needle tract after percutaneous lung needle biopsy should be carefully considered in cases of carcinosarcoma.     

Coexisting bronchial carcinoid tumor and pulmonary tuberculosis in the same lobe: a case report

The synchronous occurrence of pulmonary tuberculosis and bronchial carcinoid tumor is unusual. Although pulmonary tuberculosis can coexist with all histological types of lung cancer, few coexisting cases of bronchial carcinoid tumor and pulmonary tuberculosis have been reported. We present coexistent bronchial carcinoid tumor and pulmonary tuberculosis in the same lobe. A 39-year-old woman was admitted to our clinic with chest pain for two months. Chest radiograph showed consolidation in the right lower field. Computed tomography of the thorax demonstrated multiple mediastinal lymphadenopathies, infiltration and atelectasis in the right lower lobe. Fiberoptic bronchoscopy showed a mass lesion totally obstructing the proximal right lower lobe bronchus. The pathological diagnosis was typical carcinoid tumor. Right lower lobectomy with mediastinal lymph node dissection was performed. The pathological examination of resected material revealed coexistent tuberculosis and carcinoid tumor in the same lobe and mediastinal tuberculous lymphadenitis.     

Pyothorax associated lymphoma with increased neuron-specific enolase level in serum and pleural effusion: a case report

A 72-year-old male with a past history of artificial pneumothorax for pulmonary tuberculosis at the age of 25 was referred to our hospital for the clinical signs of pain and swelling of the back. His neuron-specific enolase values were high in both serum and pleural effusion. The computed tomography image showed a tumor mass arising from the wall of chronic pyothorax. The tumor was resected including the wall of the chronic pyothrax and right chest wall with several ribs. The tumor was 7.2 x 7.0 x 3.0 cm in size and the pathological diagnosis was non-Hodgkin's lymphoma diffuse large cell, B-cell type. Postoperative chemotherapy and radiation therapy were performed but he died of recurrence and metastasis of the tumor 5 months later after the operation.     

Reconstruction of the chest wall

In cases of malignant disease of the chest wall, such as primary tumors or extensive metastases, a particularly large resection is necessary. This leads to great problems in restoring an adequately functional chest wall. In addition to the cosmetic effect one must pay particular consideration to the dynamic parameters of pulmonary function. In a 54 years old male suffering from recurrent malignant schwannoma we performed an extensive chest wall resection. It included the ribs 3-8 on the right. The extension of the defect was 15 X 22 cm. We reconstructed the pleura with Vicryl-mesh. The covering was done with musculus pectoralis major, musculus rectus abdominis and a musculocutaneous obliquus externus abdominis flap. Three months after operation a small restriction of vital capacity is observed. In a 29 years old male partial resection of the right chest wall had to be done for a local extended chondro-sarcoma. The tumor included the ribs 4-9: chest wall defect after resection amounted to 15 X 18 cm. We performed a primary reconstruction using Vicryl-mesh as substitute for the pleura. We covered the pleura with a musculocutaneous latissimus dorsi flap. Three months after successful reconstruction the parameters of pulmonary function reached normal values again. In these and further cases the combination of Vicryl-mesh as a resorbable substitute for the pleura and musculocutaneous flaps for the chest wall has been successful in restoring a good pulmonary function.     

A case of plasma cell granuloma with good response to steroid therapy

A 46-year-old man was admitted with complaints of fever, cough and anterior chest pain. Chest X-ray examination disclosed an infiltrative shadow in the right upper lung field and chest CT scan strongly suggested invasion of mediastinum and anterior chest wall. Therefore, steroid therapy was selected because biopsy specimen showed proliferation of fibroblasts and mononuclear cells mainly containing plasma cells with no evidence of malignancy. After steroid therapy, chest X-ray examination showed that the infiltrative shadow was greatly reduced. However, since infiltrative shadow was increased again at 3 years after the initiation of steroid therapy, right upper lobectomy was performed. Histopathological analysis of resected tumor demonstrated proliferation of mature plasma cells and fibroblasts in conjunction with minor infiltration of neutrophils and lymphocytes. At 18 months after operation, new shadows appeared in right S8 and S10 which were shown to have almost the same histological findings as the resected tumor. Steroid therapy was restarted, and then the size of shadows decreased. It is conceivable that steroid therapy is an effective therapy for pulmonary plasma cell granuloma, especially multifocal and relapsing cases.     

Case of pulmonary infection with Mycobacterium chelonae in healthy breast-feeding woman

We report a case of pulmonary infection caused by Mycobacterium chelonae. The patient was a healthy breastfeeding 29 year-old female. An abnormal shadow had been pointed out by the chest X-ray in the regular checkup of the office workers. The chest X-ray film showed consolidation at right lower lung field, which initially suggested pulmonary tuberculosis. The chest CT scan showed scattered consolidation. Smears and cultures of the sputum were repeatedly positive for mycobacteria, which was identified as M. chelonae. By chemotherapy with isoniazid, rifampicin, and clarithromycin on the basis of susceptibility test, sputum converted to negative within 2 months, abnormal shadows on the roentgenogram and laboratory data showed improvement. There are no signs of recurrence after completion of the treatment for 12 months.     

Persistent pulmonary granulomas after recovery from varicella pneumonia

A 41-year-old man was found to have a miliary infiltrate on chest roentgenogram two months after recovery from varicella pneumonia. The patient remained in good health and there was no objective sign of pulmonary disease. The infiltrate showed no change in subsequent serial chest films, and after one year, open lung biopsy was performed. Histology revealed isolated necrotizing granulomas with a mononuclear infiltration and a fibrous capsule. We discuss the differential diagnosis of pulmonary granulomas and conclude that the roentgenographic and biopsy findings probably represent a persistent lesion after varicella pneumonia.     

A case of pulmonary sarcoidosis with pneumothorax and pleural effusion after improvement of pulmonary impairment]

A 23-year-old man was admitted to our hospital for a complete medical evaluation of abnormal pulmonary shadows found on a chest radiograph during his annual check-up. Chest radiography and chest CT showed a diffuse spread of micronodules in both lung fields and mediastinal lymphadenopathy. A transbronchial lung biopsy demonstrated evidence of noncaseating epithelioid cell granuloma with multinucleated giant cells, and a diagnosis of sarcoidosis was made. The pulmonary shadows improved without therapy. Twenty months later, the patient was readmitted to the hospital because of chest pain and dyspnea. Pneumothorax appeared on the right in a chest radiograph, but subsided after drainage therapy, and two weeks later, a right side pleural effusion was seen. We determined that the pleura was involved in the sarcoidosis, and the patient was treated with oral prednisolone 20 mg daily. The pleural effusion gradually subsided. This is the first reported case in Japan of pulmonary sarcoidosis with pneumothorax and pleural effusion after improvement of pulmonary impairment.     

A case of pulmonary leiomyosarcoma]

A 73-year-old woman with hemoptysis visited our hospital. Chest radiography showed a massive shadow on the right middle lung field. Bronchofiberscopic examination demonstrated a polypoid tumor obstructing the right middle lobe bronchus. A chest CT scan showed that the tumor was situated in the right middle lobe, obstructing the right pulmonary artery trunk. Sarcoma was diagnosed after a CT-guided biopsy. The tumor grew rapidly, giving rise to brain metastasis, which led to the death of the patient. An autopsy examination confirmed the diagnosis as pulmonary leiomyosarcoma.