Development of combined thymic carcinoma and thymoma in an extrathymic lesion during long follow-up for recurrent thymoma.

The present study reported a rare case of combined thymic squamous cell carcinoma and thymoma exhibiting a mass on the left chest wall. The patient underwent thoracotomy for invasive thymoma 15 years previously, however, suffered a relapse in the left intrathoracic space. Radiotherapy, chemotherapy and partial resection, as secondary surgery for the intrathoracic mass, were performed. The histological findings in the resected specimens revealed type B3 thymoma. As the patient developed a left chest wall mass and pain in 2013, the mass was resected. The histological findings indicated two separate components composed of type B3 thymoma and squamous cell carcinoma. Immunohistological findings revealed that the thymoma cells were positive for CD5, while the thymic carcinoma cells were negative for CD5. Several reports have demonstrated the coexistence of thymic carcinoma and thymoma in the primary thymus, however, the development of a combined tumor in an extrathymic lesion is extremely rare. The present case had a long follow-up for recurrent thymoma. The present case indicated that the development and/or coexistence of malignant components in the thymoma must be taken into consideration for the treatment and/or management of patients with thymoma and that a pre-existence of CD5 expression in thymoma and the lost change may be associated with the process of malignant transformation.

Benefits of video-assisted thoracic surgery for repeated pulmonary metastasectomy.

PURPOSE: The use of repeated pulmonary resection for metachronous pulmonary metastasis has increased. We assessed whether video-assisted thoracic surgery (VATS) produced greater benefits than classic thoracotomy for repeated pulmonary metastasectomy procedures. METHODS: A total of 46 patients who had undergone two or more pulmonary metastasectomies from 1995 to 2008 were analyzed in this study. These patients were classified into four groups as follows: group A (previous VATS/present VATS); group B (previous VATS/present thoracotomy); group C (previous thoracotomy/present VATS); group D (previous thoracotomy/present thoracotomy). The clinical features of these four groups were then compared. RESULTS: The operating time and the duration of thoracic drainage were longer in group D than in group A or B. The operating time was also longer in group C than in group A. Intraoperative bleeding was greater in group D patients than in other three groups. There were no discernible morbidities resulting from VATS in groups A or C. No differences were found in the occurrence of relapse among the groups. The mean interval from the previous to the present pulmonary metastasectomy also did not differ significantly among groups. CONCLUSION: VATS can result in a shortened operating time, reduced intraoperative bleeding, and generally fewer complications compared with repeated classic thoracotomy. VATS is also potentially a curative procedure as it is not inferior to classic thoracotomy in terms of the relapse rate after repeated pulmonary metastasectomy.

[Delayed hemothorax due to blunt chest trauma].

We report 2 cases of delayed hemothorax due to blunt chest trauma. A 48-year-old man who fell down and got a blow at the right chest had a checkup with a 1st aid outpatient. By the X-rays at the time of the 1st examination, the hemothorax was not noted. The next day, He has been transported to our hospital for atypical absence. Hemothorax was suggested by computed tomography (CT) and chest drainage was enforced. A 79-year-old man got a blow at the anterior chest by traffic accident and had a checkup in the 1st hospital. The abnormality was not recognized in the chest CT at that time. For the left hemiparesis, he was transported to our hospital the next day. Hemothorax was suggested by CT and chest drainage was enforced.

Giant intraatrial septal aneurysm originating from a branch of the left coronary artery.

We present the case of a 38-year-old woman who had a large intraatrial aneurysm occupied by old thrombosis. The aneurysm was successfully removed, and the atrium was repaired. Pathohistological findings indicated that the inflow artery of the aneurysm had an anomalous origin from the left main coronary artery, and its pathogenesis was unknown. It is occasionally difficult to distinguish a large coronary aneurysm from a mediastinal tumor because this aneurysm is a rare entity, even more so in an atrial septum. A giant coronary aneurysm should be considered an alternative diagnosis in the event of a mediastinal mass. Surgery is recommended for a large coronary aneurysm.

[Refractory non-small-cell lung cancer responding to combination chemotherapy with gemcitabine and cisplatin].

The patient was a 60-year-old female with adenocarcinoma of the lung. An effective radiation therapy was performed for cervical lymph node metastases found 19 months after the operation. A right adrenal metastasis and abdominal paraaortic lymph node metastases were detected 11 months later, and chemotherapy with cisplatin (CDDP) was administered. Although a temporary partial response was obtained, the metastatic lesion was refractory to CDDP. The patient was treated with gemcitabine (GEM) and CDDP, which resulted in near complete response continued for 3 months. The combination therapy of GEM and CDDP may be effective for recurrent non-small-cell lung cancer refractory to other regimens.