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 of typical carcinoid accompanied with left atrium myxoma

A 78-year-old female was admitted to Shizuoka red cross hospital because of an abnormal shadow at the right upper lung field on chest X-ray film. A left atrium myxoma was detected at chest CT scan after admission. Though the lung tumor was well defined and hilar and mediastinal lymph nodes were not swollen at CT scan, the tumor was suspected a small cell carcinoma at the result of trans-bronchoscopic biopsy. Firstly we performed removal of the left atrium myxoma, and two months later, we performed thoracotomy and partial resection of the right upper lobe. The lung tumor was finally diagnosed as a typical carcinoid. We have followed the patient for about 32 months after the operation and there is no evidence of tumor recurrence.     

Two cases of retroperitoneal functioning paraganglioma

We report two cases of retroperitoneal functioning paraganglioma. Case 1: A 52-year-old male patient was admitted to our hospital for further examination of pulsating abdominal pain with chest pain and headache. Overfist-size smooth-surfaced hard mass was palpated at the right upper abdominal quadrant. Catecholamine levels in serum and urine showed marked elevation. Computed tomographic (CT) scan, magnetic resonance imaging (MRI) and angiography revealed a large tumor between the right kidney and aorta. He underwent surgical removal of the tumor and histological examination revealed paraganglioma. His chief complaints disappeared postoperatively. Case 2: A 68-year-old female patient was admitted to our hospital for control of diabetes. An abnormal mass was shown ultrasonically at the left renal region by routine screening examination. A marked increase of noradrenaline in serum and urine was observed. Abdominal CT scan, MRI and angiography revealed a retroperitoneal tumor which was located adjoining to the lower pole of the left kidney. The tumor was removed transabdominally. Histopathological studies showed paraganglioma. After the operation her blood sugar and noradrenaline levels decreased to the normal range.     

A case report of emphysematous pyelonephritis

A 51-year-old male patient with diabetes mellitus consulted his home doctor because of high fever and right flank pain. Urinalysis showed marked pyuria. Treatment with antibiotics was not completely effective, and he was referred to our hospital for further examination and treatment. CT scan showed an abnormal gas shadow in right renal parenchyma. He was diagnosed with emphysematous pyelonephritis and right subcapsular nephrectomy was done after the control of diabetes mellitus. We reviewed 57 cases of emphysematous pyelonephritis including our case in the Japanese literature, and we discussed about its etiology, symptomatology, choice of treatment and prognosis.     

A case of bilateral renal cell carcinoma showing a rapid course of death in a long-term hemodialysis patient due to polycystic kidney

A case of bilateral renal cell carcinoma in a 42-year-old polycystic kidney male is reported. He had been treated with hemodialysis for 22 years. An abnormal small mass was found in one of the left renal cystic lesions by screening ultrasonography and CT scan at the 19th year of the hemodialysis. Left radical nephrectomy was performed and the histological diagnosis was a renal cell carcinoma (RCC). There was no evidence of recurrence and metastasis, however, he presented with asymptomatic macrohematuria two years after the operation. CT scan demonstrated the rapidly progressing right renal tumor and multiple para-aortic lymph node swelling. Right nephrectomy and lymphadenectomy were performed and pathological examination showed the advanced RCC with multiple lymph node metastasis. Eleven months after the second operation followed by interferon therapy. he died of multiorgan metastasis of the RCC. This is the first bilateral RCC case in polycystic kidney patient treated with hemodialysis in Japan.     

A surgical case of giant mediastinal neurilemmoma]

A 45-year-old male was admitted to Nagoya University Hospital with dyspnea. He was examined by chest X-ray, CT, MRI, and bronchofiberscope. The chest X-ray showed a large abnormal shadow in the right lung field. A large tumor mass pressing the right lung occupied a half of thoracic cavity on a chest CT and MRI. Bronchofiberscopic findings showed a stenosis of the right intermediate bronchus. The clinical diagnosis was posterior mediastinal tumor. He underwent a posterolateral thoracotomy and the tumor was removed smoothly. The size of resected specimen was 15 x 13 x 11 cm. Histopathological examination of the specimen revealed a mediastinal neurilemmoma. He has been well for 4 months postoperatively.     

A case of solitary metastatic lung tumor from follicular carcinoma of the thyroid in hemodialysis patient]

A 61-year-old female was admitted for abnormal shadow of chest X-ray film. The patient has been treated with hemodialysis for chronic renal failure since February 16, 1982, and was performed total thyroidectomy for follicular carcinoma of thyroid on October 24, 1989. Chest X-ray on September 8, 1994 showed the abnormal shadow of right lower lung, chest CT revealed tumor shadow which is suspected to malignancy. We performed partial resection of right lung including tumor on October 19, 1994. Histological examination certified the lung metastasis of follicular carcinoma of thyroid. Postoperative course has been uneventful and there has been no episode of recurrence for 3 years and half after the surgery. We reported this very few case with solitary metastatic lung tumor from follicular carcinoma of thyroid with a review of the literature.     

Posterior mediastinal paraganglioma

We report a case of 26-year-old man with a posterior mediastinal paraganglioma. Although he was asymptomatic, chest abnormal shadow was pointed out by the regular medical screening with chest X-rays. A chest computed tomography (CT) showed a left posterior mediastinal tumor with strong enhancement. He was referred to our hospital for surgery. We tried a video-assisted thoracic surgery (VATS) for resection of the tumor, but additional small thoracoscopy was necessary for control of bleeding. The patient's vital sign was stable at perioperative course. The histopathological examination revealed no evidence of malignancy, and a final diagnosis of paraganglioma was made. His postoperative course was uneventful, and is currently doing well without sign of recurrence. Because metastasis and/or local recurrence of paragangliomas is difficult to predict accurately only by histopathological finding, long-term follow-up is thought to be essential after surgery.     

Primary T-cell type lymphoma of the central nervous system: a case report

A case of T cell type primary lymphoma of the CNS is reported. A 50-year-old man was admitted because of speech and memory disturbance and dyscalculia. He had suffered from uveitis of both eyes two years before admission. Neurological examination revealed motor aphasia, finger agnosia, dyscalculia and memory disturbance. CT scan showed a mass lesion which was enhanced irregularly by the contrast medium in the left temporoparietal region. CAG confirmed the presence of a left temporoparietal avascular mass. Total removal of the tumor was performed through the left temporoparietal craniotomy. Histopathological diagnosis of the tumor was malignant lymphoma (diffuse, large cell type). Immunological study with tumor cells in the cerebrospinal fluid revealed that the tumor was T cell type malignant lymphoma. After postoperative whole CNS irradiation and intrathecal methotrexate injection, his preoperative symptoms disappeared. No evidence of the tumor recurrence is seen under CT scan one year and two months after the tumor resection. Relationship between the cell type of the tumor and CT findings is discussed.     

Two cases of pulmonary leiomyosarcoma

Pulmonary sarcoma is a rare tumor of the lung. There are 81 cases in the literature for review, including our two cases. Our first case who was a thirty-seven year old male who was admitted to our hospital with complaints of left back pain. His chest X-ray showed an 11 X 14 cm tumor shadow in the lower left lung area. A left upper lobectomy was performed, and the histological diagnosis was leiomyosarcoma of the pulmonary vein. He died due to mediastinal recurrence 29 months later. Our other case was a fifty-six year old female. Her chest X-ray showed an abnormal shadow that was a tumor shadow in the right central lung area of 4 cm in diameter. As the diagnosis of the transcutaneous lung biopsy was benign tumor, partial resection of lung was performed. The histological diagnosis was leiomyosarcoma of the bronchus, and she is alive and well at 29 months after the operation. As the rate of diagnosis in leiomyosarcoma detected by transcutaneous lung biopsy is low, the most acceptable method of diagnosis is a total examination, including cytology of sputum, bronchoscopic findings, and roentgenoscopy. Probe thoracotomy would also be necessary if malignancy could not ruled out. The treatment of lobectomy should include lymph node resection.     

Bilateral renal cell carcinoma: report of a case

A case of asynchronous bilateral renal cell carcinoma is reported. The patient was a 71-year-old man who visited our clinic with complaints of asymptomatic macrohematuria and fever on November 20, 1960. Clinical diagnosis was left renal tumor and left nephrectomy was performed on December 4, 1960. Histological diagnosis was renal cell carcinoma (common type, clear cell subtype, alveolar type and G1). The postoperative course was uneventful until complaints of diarrhea and weight loss in November, 1983. He visited our clinic again with a right abdominal mass on January, 1984. Right renal selective angiography revealed an enlargement and abnormal vascularity with tumor stain, hypervascularity and pooling in the whole kidney except for the upper pole lesion. CT scan revealed a space occupying lesion. Right radical nephrectomy was performed on March 6, 1984. Histological diagnosis was renal cell carcinoma (common type, mixed subtype, alveolar and tubular type, G2). He was treated by hemodialysis and steroid therapy after right nephrectomy but he died of massive gastro-intestinal bleeding on April 22, 1984. The paper is the 15th report of a bilateral renal cell carcinoma in Japan.     

A case report of retroperitoneal malignant schwannoma

A case of retroperitoneal malignant schwannoma is reported. The patient was a 66-years-old man who was referred to our clinic because of an abdominal lump. CT scan and renal arteriography pointed out right renal cyst, but the tumor was separate from the right kidney at operation. Pathological diagnosis of this retroperitoneal tumor was malignant schwannoma. After 10 months he developed local recurrence and had transabdominal excision. He has been doing well 12 months after the second operation. Thirty-one cases of retroperitoneal malignant schwannoma in Japan are reviewed.     

Surgical treatment of cerebral paragonimiasis miyazakii

An operated case of cerebral paragonimiasis miyazakii was reported. A 25-year-old man was admitted to our hospital on Jan. 25, 1982, because of weakness, sensory disorder and focal convulsion of the right upper limb. He complained of slight headache but had no sign of meningeal irritation nor inflammation. CT scan revealed a left parietal low density mass with irregular ring-like contrast enhancement. Left carotid angiogram showed stretched arteries around the mass. Laboratory findings were normal except for eosinophilie (17%). Chest X-P was normal. Operation was performed under diagnosis of glioblastoma on Aug. 6, 1982. The tumor was well-circumscribed and had a firm capsule which containing necrotic substance. The tumor was removed totally and the bone flap was also removed since slight brain swelling was seen. Histologically it proved to be a granuloma and four eggs of helminth were found in the necrotic tissue. Post operative state of the patient was satisfactory and cranioplasty was performed 3 weeks later. On Aug. 31, he began to complain of chest pain, cough and hemosputum, and chest X-P disclosed a nodular shadow in the lower lobe of the right lung. Paragonimiasis was strongly suspected because he had a history of having three fresh-water crabs (Potamon dehaani) 18 months before. But not egg was found in either sputum nor stool. Skin test with paragonimus westermani antigen was highly positive.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of synchronous contralateral renal cell carcinoma and ureteral transitional cell carcinoma

A case of synchronous contralateral renal cell carcinoma and ureteral transitional cell carcinoma is reported. A 56-year-old man, who had been incidentally found to have an abnormal mass in the upper pole of the right kidney on ultrasound sonography, was admitted on January 8, 1985. CT scanning and renal arteriography revealed right renal malignancy. Right radical nephrectomy was performed and histological examination showed adenocarcinoma, granular cell type of the right kidney. He was discharged on February 3, 1985. Two months postoperatively, he was rehospitalized for macroscopic hematuria. Left retrograde pyelogram showed obstruction at middle ureter and cytology of urine from left ureter was positive. So a left ureteral tumor was suspected, and partial resection of left ureter and ureteroureterostomy were performed. Histological examination revealed ureteral transitional cell carcinoma. He is now doing well at 6 months following the lat surgery, without any evidence of recurrence.     

A case of bilateral renal cell carcinoma

A 69-year-old man visited our clinic with the chief complaint of macroscopic hematuria. On CT scanning and renal arteriography, a round tumor about 3 cm in diameter on the frontlateral phase of the left kidney and another tumor ranging from the upper pole to the center of the right kidney were recognized. Under the diagnosis of bilateral renal tumor, first in November 1980 left partial nephrectomy was performed to extirpate the tumor. Then, upon recovery from postoperative transient renal hypofunction, right nephrectomy was performed in January 1981. After the operation renal hypofunction was noted again, but in March of the same year he was discharged as his creatinine value was stabilized to 3 approximately 4 mg/dl. Histopathologically the tumor of the left kidney was clear cell subtype and that of the right kidney was granular cell subtype of renal cell carcinoma. He has been followed up under administration of PSK and CQ in the outpatient clinic. As of January, 1985 he is well without recurrence or metastasis.     

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.     

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.     

Mucosa-associated lymphoid tissue lymphoma; report of two cases

Primary pulmonary malignant lymphoma is a rare disease that is thought to belong to a category of malignant lymphomas arising from mucosa-associated lymphoid tissue (MALT). We presented 2 cases of MALT lymphoma. Case 1: In a 39-year-old woman, an abnormal shadow was detected in chest radiography in the left S3. The diagnosis was organizing pneumonia in consequence of the further examination. One year after an growing abnormal shadow was detected again, we performed the tumor resection with the thoracoscopy in the possibility of malignancy. The pathological diagnosis was MALT lymphoma. Case 2: In a 70-year-old man, middle lobe syndrome was detected in chest radiography. As a result of the bronchial biopsy, the lesion was suspected of MALT lymphoma. Right middle lobectomy was performed, and the tumor was diagnosed as a MALT lymphoma histologically. He underwent an effective postoperative radiotherapy and has had no evidence of recurrence.     

Synchronous neoplasms of the colon and kidney: analysis of 2 case reports

Up until only a few decades ago synchronous renal cell carcinoma associated with primary tumors of other organs was diagnosed almost exclusively in necropsy series. Recently the widespread use of ultrasonography and CT has permitted diagnosis of clinically silent renal cell carcinoma in patients undergoing a work-up for other primary tumors. We report two cases of synchronous colon and renal cancer: 1) a 75 year old woman presented bilateral pulmonary nodules at chest X-Ray and stratigraphy. Total-body CT scan showed multiple, apparently metastatic, bilateral pulmonary lesions and two tumors in the right kidney and ascending colon. A right nephrectomy and right hemicolectomy were performed. She succumbed after 18 months as a result of metastatic spread to the liver, lungs and bone; 2) a 64 year old man was discovered to have a colon cancer during a barium enema examination and endoscopy. CT scan of the abdomen yielded an incidental diagnosis of a tumor in the left kidney. A left nephrectomy and left hemicolectomy were performed. After 6 months CT revealed no evidence of recurrence or metastases. Histology findings revealed two primary malignancies in both cases: a clear cell renal carcinoma and an adenocarcinoma of the colon.     

A case of dumbbell neurogenic tumors of the mediastinum

A 49-year-old man was admitted for the further examination of the abnormal shadow of the left posterior mediastinum, which was incidentally detected on routine chest X-ray. He has no complaints, and no abnormalities on neurological examination. Thoracic spine X-ray showed the destruction of the T12 vertebral body and the dilatation of the left intervertebral foramen between T12 and L1. Myelography showed no abnormalities, but contrast-enhanced CT scanned just after myelography revealed the extradural dumbbell-formed tumor. One stage removal of the tumor was safely performed through left posterolateral thoracotomy and transthoracic partial laminectomy. Postoperative course was uneventful. The tumor was histologically schwannoma, originated from the left thoracic sympathetic trunk. We think that this procedure is available for the operation of a kind of dumbbell tumor of the posterior mediastinum.