Airway stent intervention in a high-volume center: safe procedures and educational perspectives.

Background: Airway intervention, including stenting, can rapidly improve a patient's respiratory condition, but the procedure requires highly specialized techniques and expertise. Therefore, educating young endoscopists and passing on the techniques are major issues. However, the best way to educate new doctors on these techniques remains unclear. This study analyzed our educational system for airway intervention and its outcomes. Methods: Patients who underwent airway intervention regarding airway stents under general anesthesia in our department between January 2010 and September 2023 were included. The outcomes of interventions related to airway stents in our hospital were evaluated retrospectively, including from an educational perspective. Results: A total of 96 patients (76 undergoing stenting for airway stenosis, 8 stenting for airway-esophageal fistula, and 12 stent removal) were analyzed. The median experience level of the main physician was 5 (range, 1-17) years, and that of the supervising physician was 18 (range, 5-23) years. The median number of physicians who participated in the interventions was four. A rigid bronchoscope was used in 86.5% of cases. The procedure success rate was 95.8%. Intraoperative complications occurred in 8.3% and postoperative complications in 10.5% of cases, and there was 1 procedure-related death (1.3%). In the analysis of factors related to the development of complications, the years of experience of the main physician had no influence. Conclusions: These findings indicate that our method of airway intervention is safe. Young endoscopists were able to master the technique by gaining experience under the supervision of experts.

Multiple solitary fibrous tumors of the pleura with multicentric and unilateral involvement: a case report.

BACKGROUND: Solitary fibrous tumor of the pleura (SFTP) is a mesenchymal tumor. Patients with SFTP generally have only one lesion. We herein report an extremely rare case of multiple SFTPs that were multicentric and unilateral. CASE PRESENTATION: The patient was a 21-year-old asymptomatic young man who was referred to our hospital due to abnormal shadows on a chest X-ray. Computed tomography showed 6 tumors of heterogeneous sizes in the left thoracic cavity. The tumors were suspected to be multiple benign or low-grade malignant thoracic tumors, and tumor resection was performed. The tumors had almost the same appearance, with uniform fibroblastic spindle cell proliferation, and arose from the pleura in microscopy. Immunohistochemical staining revealed that the tumor cells were positive for CD34, CD99, Bcl-2, and STAT6. Based on these findings, the tumors were diagnosed as multiple SFTPs with multicentricity. At 1 year and 6 months after the first surgery, 2 new lesions were found above the diaphragm, and these were resected. These tumors were arose from the pleura with a fibrous capsule structure. Their pathological findings were identical to the initial tumor without evidence of malignant transformation. CONCLUSION: We experienced an extremely rare case of multiple SFTPs with multicentric and unilateral lesions.

Parahiatal Hernia Sac Tumor of Localized Malignant Peritoneal Mesothelioma.

We describe an extremely rare case of a parahiatal hernia sac tumor. A computed tomography scan showed a solitary mass located adjacent to the diaphragm and esophagus in a 72-year-old woman. Thoracoscopic surgery revealed that a tumor protruded through a diaphragmatic defect lateral to the crus and adhered to the perigastric fat in the gastric fundus. Radical resection of the tumor and herniorrhaphy of the diaphragmatic defect were performed. Pathologic and clinical findings indicated this was a parahiatal hernia sac tumor of localized malignant peritoneal mesothelioma. No recurrence was observed without adjuvant therapy 10 months after surgery.

[High-grade Fetal Lung Adenocarcinoma with Hepatoid Adenocarcinoma Component].

A 71-year-old man with a history of smoking 1 pack of cigarettes per day for the past 53 years visited our department with chest pain, and was diagnosed as spontaneous pneumothorax. A chest computed tomography scan revealed a nodular shadow in the upper portion of the left lobe of the lung, which was found to be adenocarcinoma by transbronchial lung biopsy. A left upper lobectomy and lymphadenectomy were performed. The pathological diagnosis was a high-grade fetal lung adenocarcinoma (H-FLAC) with a hepatoid adenocarcinoma component (pT2aN0M0, pStage I B). H-FLAC comprises at least 50% fetal lung-like cells, while hepatoid adenocarcinoma comprises hepatocellular carcinoma-like cells. Following the diagnosis, adjuvant chemotherapy with uracil-tegafur was started. Although both these neoplasms are known to have a poor prognosis, no recurrences were observed at 11 months postsurgery.