[Malignant Solitary Fibrous Tumor Compressing the Right Ventricle].

An 84-year-old woman was referred to our department with an abnormal mass detected on a chest computed tomography (CT) scan. The CT scan revealed a tumor between the sternum and the right ventricle, fed by the left internal thoracic artery. Multiple hepatic nodules were also observed. An ultrasound-guided biopsy was performed on the liver nodule, which was diagnosed as a solitary fibrous tumor. The tumor was compressing the heart, and the patient was at risk of sudden death, therefore, a decision was made to resect tumor. Preoperative embolization of the left internal thoracic artery was performed to prevent massive intraoperative bleeding. The tumor was resected via a median sternotomy approach. Intraoperatively, feeding vessels entering the tumor from the diaphragm were also identified. Total blood loss was 70 ml. The postoperative course was uneventful.

[Solitary Pulmonary Metastasis of Pancreatic Cancer Seven Years after Pancreatoduodenectomy That Needed to Differentiate from Primary Lung Cancer].

The indications for resection of pulmonary metastases of pancreatic cancer are controversial even now. We report a 63-year-old woman who was found a pulmonary nodule in the apical area of the left lung by chest computed tomography (CT) seven years after pancreatoduodenectomy for pancreatic cancer. Since the nodule was located adjacent to the left subclavian artery, we performed surgery for diagnosis and treatment without biopsy. The final pathological diagnosis was pulmonary metastasis of pancreatic cancer. The patient received adjuvant chemotherapy after lung resection and has remained relapse-free for 12 months.

[Ectopic Cervical Thymoma that was Difficult to Differentiate from Thyroid Tumor:Report of a Case].

We report a case of ectopic cervical thymoma that was difficult to differentiate from thyroid tumor. A 69-year-old woman was referred to our hospital with a tumor on the left side of the neck. Fine-needle aspiration cytology could not establish the diagnosis and the surgery was then performed for diagnosis and treatment. Since the intraoperative pathological diagnosis was also inconclusive, thymectomy was performed because of the macroscopic finding suggesting close relation to the thymus. The final pathological diagnosis was type AB thymoma.

[Experience with Pleural Metastasis from Hepatocellular Carcinoma;Report of a Case].

A 69-year-old man with a ruptured hepatocellular carcinoma(HC) was treated by hepatic transcatheter embolization (TAE) followed by upper segmentectomy of the liver. He developed postoperative intrahepatic recurrence and was treated with transcatheter arterial chemoembolization (TACE) at 6 months and 12 months postoperatively. Furthermore, chest computed tomography (CT) revealed a nodule suspected to be pleural metastasis 12 months postoperatively. Pathological assessment of a CT-guided biopsy of the nodule confirmed pleural metastasis of HC. Surgical resection of the metastatic tumor and adjuvant chemotherapy was performed. Despite developing lung metastasis, the patient has survived for more than 20 months. Early detection and treatment of pleural metastasis of HC might help to prolong survival.

The first case of COVID-19 occurring as community-acquired pneumonia in Hokkaido, Japan and our preventive measures against nosocomial infection.

We report a case of a 59-year-old man with coronavirus disease 2019 (COVID-19). He had visited a hospital for fever and cough and been treated with antibiotics for pneumonia in the right upper lobe. However, he gradually progressed to dyspnea and consulted our hospital. His chest radiographs showed bilateral pneumonia shadows and his CT showed ground glass opacities and consolidation. Although we treated him with broad-spectrum antibiotics, the pneumonia shadow rapidly progressed and mechanical ventilation was administered. We collected sputum from the bronchus using bronchoscopy to detect microorganisms, and RT-PCR tests confirmed COVID-19 pneumonia. He was transferred to a designated hospital. In order to prevent the occurrence of nosocomial infections, close contacts within the hospital and medical staff were suspended from their work for two weeks. No secondary infection with COVID-19 appeared. This was the first case of COVID-19 occurring as community-acquired pneumonia in Hokkaido, Japan.

[Case of drug-induced angioedema (DIAE) on induction of anesthesia with difficult ventilation due to oropharyngeal edema].

A 69-year-old man with a past history of hypertension on angiotensin II receptor blocker (ARB) for three months presented for radical prostatectomy. Immediately after induction of anesthesia with fentanyl and propofol, mask ventilation became difficult, although no significant hemodynamic changes occurred. Fiberoptic examination revealed severe oropharyngeal edema, but, the trachea was successfully intubated. Afterward, the operation proceeded without complications. He stayed in the ICU for 4 days until the trachea was extubated successfully. He was diagnosed with DIAE because of his history of dyspnea with exclusion of other possible pathophysiological conditions.

[Lung cancer incidentally detected at the treatment of pneumothorax ; report of two cases].

We report 2 cases of lung cancer incidentally detected following pneumothorax. Case 1:A 40-year-old man complaining of dyspnea was admitted with right pneumothorax. Chest computed tomography (CT) after chest drainage showed a cavitary nodule with pleural indentations in the right lower lobe. It was indicated at surgery that pneumothorax was caused by perforation of the tumor into the pleural cavity. Right lower lobectomy was performed because the pathological diagnosis of the nodule was a large cell carcinoma. The final histopathological diagnosis was stage II A (pT2aN1M0). The patient died of recurrence 14 months after surgery. Case 2:A 47-year-old man who admitted with right pneumothorax was found to have a nodule with pleural indentations closely a bulla at the apex of the right lung by chest CT after chest drainage. Pneumothorax was indicated to be caused by rupture of the bulla at surgery. Right upper lobectomy was performed because the pathological diagnosis of the nodule was a squamous carcinoma. The final histopathological diagnosis was stage I A (pT1bN0M0). The patient is alive at 2 years after the operation without recurrence. Lung cancer detected following pneumothorax which was caused by perforation of the tumor is generally considered to have poor prognosis. Whereas, prognosis of lung cancer incidentally detected following pneumothorax depends on its staging.

[Mediastinal goiter; report of a case].

A 76-year-old female was admitted to our hospital because of an abnormal shadow on chest computed tomography (CT) which showed the tumor extending from left lower end of the thyroid to the aortic window along the left side of the trachea, indicating the retrosternal goiter. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were within normal ranges. The tumor was resected through cervical collar incision and median sternotomy. The pathological diagnosis was an adenomatous goiter. The patient was discharged without complications.

[Catamenial pneumothorax; report of a case].

A 39-year-old woman was referred to our hospital because of pneumothorax related to menstruation. Chest X-ray showed right pneumothorax. Right thoracoscopy revealed 3 fenestrations on the diaphragm. Partial resection of the diaphragm including these lesions were performed. Intrathoracic minocycline was applied expecting pleural adhesion after surgery. Histopathological examination confirmed the presence of endometriosis on the resected diaphragm.