Mesenteric Myxofibrosarcoma: A Case Report.

Myxofibrosarcoma is a soft tissue sarcoma that occurs in elderly patients. Primary myxofibrosarcoma rarely arises in the mesentery; this is the fourth known case of myxofibrosarcoma presenting as a mesenteric tumor. A 62-year-old male with a mesenteric myxofibrosarcoma presented with an abdominal mass; his symptoms were frequent urination and a sense of abdominal pressure. He was admitted for further examination. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mesenteric lesion. The preoperative diagnosis was a suspected malignant myxoid tumor. We performed a curative resection with wide margins. The histopathological and immunohistochemical findings confirmed that the tumor was mesenteric myxofibrosarcoma. The postoperative course was uneventful, and there have been no signs of relapse for three years to date after surgery. It is difficult to make a definitive diagnosis of mesenteric myxofibrosarcoma using only CT or MRI. However, when the preoperative findings suggest a malignant mesenteric tumor, then the best practice is resection with sufficient margins.

Lung function in the late postoperative phase and influencing factors in patients undergoing pulmonary lobectomy.

BACKGROUND: Lung function in the late postoperative phase after pulmonary lobectomy is insufficiently characterized. This study aimed to appraise lung function in the late postoperative phase according to vital capacity (VC) and forced expiratory volume in 1 second (FEV1) in patients who underwent pulmonary lobectomy. METHODS: Pre- and postoperative VC and FEV1 were reviewed in 112 patients who underwent pulmonary lobectomy. Postoperative lung volume was assessed >1 year after surgery. Postoperative decreases in VC and FEV1 were compared with preoperative predicted values among patients who underwent resection of specific lobe. Determinants effecting a decrease in lung function were also investigated. RESULTS: A mean postoperative decreased VC of 10.5%±1.8% was recorded in patients who underwent right upper lobectomy (RU), 7.2%±1.5% for right middle lobectomy (RM), 14.3%±2.3% for right lower lobectomy (RL), 16.6%±3.0% for left upper lobectomy (LU), and 14.7%±2.5% for left lower lobectomy (LL). Corresponding FEV1 values were 14.8%±1.8% for RU, 11.9%±4.0% for RM, 14.9%±2.3% for RL, 17.9%±2.9% for LU, and 15.1%±2.4% for LL. The actual decreasing rate of VC was overestimated in patients who underwent RU, RL, LU, and LL. In contrast, FEV1 was overestimated only in patients who underwent RL and LL. Patients with chronic obstructive pulmonary disease (COPD) exhibited significantly better preservation of FEV1. CONCLUSIONS: Patients scheduled for RL and LL, or those with COPD, appeared to exhibit preserved lung function in the late postoperative phase after pulmonary lobectomy.

Ectopic Cervical Thymoma Excised through a Transcervical Approach Combined with Video-assisted Thoracoscopic Surgery: A Case Report.

Ectopic cervical thymoma (ECT) is a rare tumor. We present a case of 56-year-old woman with an ECT in the anterior neck that was correctly diagnosed preoperatively. The patient had no symptoms of myasthenia gravis or other immune disorders, and the tumor was not invading any adjacent structures. We performed tumor resection and thymectomy through a transcervical approach using video-assisted thoracoscopic surgery with a multi-access single port. To our knowledge, this is a novel combined technique for the resection of an ECT.

Neutrophil elastase activity in pulmonary venous blood during lung resection.

OBJECTIVES: Neutrophil elastase has been reported to play an important role in acute lung injury, which is a major cause of postoperative mortality after pulmonary resection. Neutrophil elastase released in the lungs reaches the peripheral circulation via the pulmonary veins. This study was performed to compare neutrophil elastase activity in pulmonary venous blood (collected during lobectomy) with that in the peripheral blood, and to determine the perioperative changes of neutrophil elastase activity. METHODS: In 34 patients undergoing lobectomy with mediastinal lymph node dissection, the leucocyte count, neutrophil count, neutrophil elastase activity and levels of tumour necrosis factor-α, interleukin-6 and interleukin-8 were measured in the pulmonary venous blood and peripheral arterial blood before and after surgery. Then, these parameters were compared between before and after surgery with peripheral and pulmonary blood. RESULTS: Neutrophil elastase activity was found to be significantly higher in pulmonary venous blood at the completion of surgery than at the start (during thoracotomy), while the neutrophil elastase activity of peripheral arterial blood showed no significant change between the start and completion of surgery. CONCLUSIONS: In conclusion, measurement of neutrophil elastase activity in pulmonary venous blood revealed changes associated with lobectomy.

Factors related to an early restoration of exercise capacity after major lung resection.

PURPOSE: We attempted to identify the factors related to an early restoration of the exercise capacity after lung resection. METHODS: Major lung resection was performed in 164 patients. Exercise testing and spirometry were performed before surgery, and 2 weeks and 1 month afterward. During exercise, the maximum oxygen uptake per minute per m(2) of body surface area (VO(2)max/m(2)) was measured. The percent change of VO(2)max/m(2) at 2 weeks and 1 month after surgery was calculated by setting the preoperative VO(2)max/m(2) value as 100%. Patients were then assigned to the early restoration group or late restoration group according to their VO(2)max/m(2) measured 2 weeks after surgery. Preoperative cardiopulmonary function, as well as various preoperative and intraoperative factors were compared between the two groups. RESULTS: At 2 weeks after surgery, the mean VO(2)max/m(2) was 80.9% compared with that before surgery, and was 88.1% at 1 month. A multivariate analysis showed that the surgical method used (thoracotomy and mediastinal lymph node dissection) had a significant effect on the postoperative restoration of the VO(2)max/m(2). CONCLUSION: An early restoration of exercise capacity after lung resection is possible in patients without mediastinal lymph node dissection and in those who have a small thoracotomy wound.

Thymic basaloid carcinoma with hepatic metastasis.

A thymic basaloid carcinoma is rare, as is an unusual case with extra-thoracic metastasis. We report on a 41-year-old woman who had a thymic basaloid carcinoma with liver metastases. The patient underwent resection of the thymic basaloid carcinoma followed by curative partial hepatectomy. At 1 year later, another metastatic lesion developed in the residual liver, which was also curatively resected. The postoperative course was uneventful, and the patient is surviving without recurrence for 12 months, to date.