Biphasic pulmonary blastoma: report of a case.

A 73-year-old male presented with bloody sputa for a month. Chest computed tomography (CT) showed a large mass about 7 cm in diameter in the right lower lobe. Bronchoscopic curette cytology revealed class V and a suspected adenocarcinoma, although a systemic evaluation demonstrated no metastatic lesion. The patient underwent a right lower lobectomy and mediastinal dissection. A biphasic pulmonary blastoma was histologically diagnosed by a characteristic finding that it was mainly constituted of immature tumor tissue that had both epithelial and mesenchymal components. No mediastinal lymph node metastasis was proven. Stage T2N0M0 disease was diagnosed, and the patient chose not to undergo postoperative adjuvant chemotherapy; he remains well without recurrence 36 months after the operation.

Multiple thoracoabdominal gunshot wounds with complicated trajectories.

A 41-year-old man was shot three times with a custom-made handgun. There were six small round wounds on the surface from two bullets that went into the body and one bullet found in a wall behind the victim at the scene. The gunshot wound in the left supraclavicular region bled massively. He was transferred to our hospital and soon fell into shock. A chest radiogram showed right hemothorax. Resuscitation and blood transfusion were started, and right thoracic drainage was immediately undertaken. The left subclavicular region was incised, and bleeding from the left subclavian vein stopped. Right thoracotomy was done, and bleeding from the lung was controlled. Laparotomy was needed to look for the missing trajectory. Speculation regarding trajectories of bullets in patients with multiple thoracoabdominal gunshot wounds is difficult, and an emergent operation is often needed to control bleeding or to evaluate possible organ injury.

Successful resection of massively enlarged residual pulmonary metastases from a nonseminomatous germ cell testicular tumor.

A 25-year-old man was referred to our hospital in June 2000 for treatment of massive enlargement of residual pulmonary metastases from a nonseminomatous germ cell testicular tumor. He had undergone right orchiectomy followed by cisplatin-based combination chemotherapy 7 years ago. Chest radiography and computed tomography showed complete opacification of the left hemithorax with mediastinal shift to the right, and two smaller nodules in the right lung. After salvage chemotherapy, elevated serum alpha-fetoprotein concentrations decreased to the normal range. Considering this response, we successfully resected the metastases via median sternotomy. Postoperative pathologic examination disclosed metastatic germ cell tumors composed of mature teratoma. The patient recovered uneventfully and has been alive for 6 years since residual metastasectomy. When technically possible, resection of even massive pulmonary metastases after a favorable response to chemotherapy for a nonseminomatous germ cell tumor, can provide pathologic assessment of the response and offer patients a chance of long-term survival.

Mediastinal malignant fibrous histiocytoma developing from a foreign body granuloma.

A patient with mediastinal malignant fibrous histiocytoma (MFH) apparently developing from a foreign body granuloma is reported. A 72-year-old man was admitted to our hospital complaining of generalized fatigue and palpitations. He had undergone surgery for pulmonary tuberculosis 46 years previously. Radiography and computed tomography of the chest showed a round 5-cm mass with marginal calcification in the right side of the anterior mediastinum. The mass was resected completely via median sternotomy. Intraoperative diagnosis of foreign body granuloma was made, based on gauze fragments found in the mass and intraoperative pathologic findings suggesting benign granulation tissue. The postoperative histopathologic diagnosis was myxoid MFH. To our knowledge, mediastinal MFH developing from a foreign body granuloma has not been reported previously.

Synchronous double cancers developing from the wall of bullae in the bilateral lungs.

A rare case of synchronous double lung cancers having developed from bilateral bullous disease is reported. A 51-year-old man was admitted because of severe cough. Imaging studies revealed a left apical bulla measuring 10 cm, and another bulla measuring 8 cm containing viscous fluid on the right apex. In the next year, chest computed tomography showed increased size of the mass in the right apical bulla. Upper right lobectomy and left bullectomy were performed. Histological examination of the resected specimens revealed a large cell carcinoma having developed the wall of the bulla in the right apex, and a moderately differentiated papillary adenocarcinoma having developed in the wall of the left bulla. The patient had an uneventful recovery and has been in good health without recurrence for 3 years since surgery. We emphasize the need to be aware of the potential development of lung cancer in patients with bullous disease.