[Descending Necrotizing Mediastinitis with Empyema Necessitated Two Performances of Surgical Drainage for Successful Treatment:Report of a Case].

The case was a 57-year-old woman. She visited a local doctor with a chief complaint of sore throat. A retropharyngeal abscess was suspected, and she was referred to our otolaryngology. Contrast-enhanced computed tomography(CT) scan revealed continuous fluid retention from the retropharyngeal space to the neck and the superior and posterior mediastinum with bilateral pleural effusion. The patient was diagnosed with descending necrotizing mediastinitis with empyema, and on the same day cervical drainage, thoracoscopic bilateral mediastinal drainage, empyema curettage and tracheostomy was performed. Postoperative contrast-enhanced CT scan revealed a widespread residual mediastinal abscess and thoracoscopic bilateral mediastinal drainage was performed again on the 11th postoperative day. After reoperation, the inflammation gradually subsided and she was discharged 47 days after reoperation.

[The Postoperative Recurrence of Adenosquamous Cell Carcinoma of the Lung as a Polypoid Mass in the Tracheal Lumen;Report of a Case].

The case is 77 years old, female. She was referred to a local doctor with a chief complaint of cough and wheezing and was treated as asthma. However, symptoms did not improve and she was referred to our hospital. She had a history of right upper lobectomy for lung cancer about 2 years before, with the pathological diagnosis of adenosquamous cell carcinoma, pT1aN0M0, stage I A. Chest computed tomography (CT) scan showed a pedunculated polypoid mass almost occupying the lumen in the trachea immediately above the tracheal bifurcation, and the emergency bronchoscopic resection using a high-frequency snare under general anesthesia was performed. Postoperatively, 50 Gray of radiotherapy was added.

[Endobronchial Hamartoma of the Subsegmental Bronchus;Report of a Case].

The case was 56 years old male. An abnormal shadow was pointed out by chest computed tomography (CT) at a medical examination. The CT scan revealed a 13 mm mass shadow that contacts with the B5a of the right middle lobe. Bronchoscopy revealed a yellow colored lesion that occluded B5ai. A non-cartilage type endobronchial hamartoma was suspected and the biopsy was performed, but a definitive diagnosis was not achieved. The lesion was surgically resected by the right middle lobectomy, and the histopathological diagnosis was an endobronchial hamartoma consisting mainly of mature adipose tissue.

[Synchronous Thymic Carcinoma and Primary Lung Cancer].

A 79-year-old woman visited a local doctor with a chief complaint of cough. A computed tomography (CT) scan revealed an anterior mediastinal tumor and 20 mm sized ground-glass nodule (GGN) in the right upper lobe. Bronchoscopy was performed, but no definitive diagnosis was made for GGN and follow-up observation was made with an image. The anterior mediastinal tumor was a solid tumor of 50 mm in size, and invasive thymoma was suspected. A total thymectomy with pericardial partial resection was performed through a median sternotomy. Histopathological diagnosis was squamous cell carcinoma, and no pericardial infiltration was observed. On the other hand, GGN of the right upper lobe during follow-up increased in size and thoracoscopic surgery was performed 3 months after surgery for thymic carcinoma. Adenocarcinoma was diagnosed by rapid diagnosis and the upper lobectomy with lymph node dissection were conducted. No signs of recurrence have been observed for 5 years after operation.

[Bronchogenic Cyst in the Anterior Mediastinum;Report of a Case].

The case is 61 years old, female. The mediastinal mass was pointed out at a medical examination, and she visited our hospital. A plain computed tomography (CT) scan showed a 12×35 mm mass in the anterior mediastinum, and a thymoma was suspected. Magnetic resonance imaging( MRI) showed low signal at T1-weighted image and high signal at T2-weighted image. A benign cystic mass such as a thymic cyst and a pericardial cyst was suspected, and thoracoscopic resection was performed. Pathologically, a bronchogenic cyst was diagnosed.

[Primary Pleomorphic Rhabdomyosarcoma of the Chest Wall;Report of a Case].

The case was 70 years old, female. She visited a nearby hospital complaining of a mass in the right breast which was diagnosed as a chest wall tumor and referred to our department. A computed tomography (CT) scan revealed a 10 cm-sized contrast enhanced mass with bone destruction of the 3rd and 4th ribs. Invasion to the mammary gland tissue was not observed. A malignant tumor was suspected by percutaneous needle biopsy and the tumor was excised with the chest wall including the 3rd, 4th and 5th ribs. Histopathological diagnosis was a pleomorphic rhabdomyosarcoma. No signs of recurrence have been observed for 5 years after the operation.

[Utility of Prophylactic Administration of Pegfilgrastim in Breast Cancer Chemotherapy].

Febrile neutropenia(FN)is a frequent adverse event observed in cancer patients undergoing chemotherapy that may cause life-threatening infections. However, reducing the dose of anti-cancer drugs for breast cancer in adjuvant settings to prevent FN has been reported to adversely affect patient survival. Therefore, it is important to administer therapeutic agents as per their prescheduled regimens without delays or reductions in the dosage. From April 2015 to September 2017, pegfilgrastim was administered to 24 patients with breast cancer(primary prevention in 11 patients and secondary prevention in 13 patients)to prevent FN during chemotherapy in either adjuvant or metastatic settings. We were able to reduce the incidence of FN through prophylactic administration of pegfilgrastim without encountering serious adverse events. The inclusion of pegfilgrastim is considered essential for the safe administration of chemotherapy according to a preplanned schedule. Here, we discuss the indications, efficacy, and safety of the drug.

Candidate biomarkers predictive of anthracycline and taxane efficacy against breast cancer.

BACKGROUND: Since breast cancer shows diversity in clinical behaviors, a standard therapy does not always lead to favorable outcomes. MATERIALS AND METHODS: The expression statuses of candidate markers, including topoisomerase-II alpha (TOP2A), beta-tubulin (B-tub), and tissue inhibitor of metalloprotease-1 (TIMP-1), were immunohistochemically evaluated in 70 breast cancer tissues from 68 patients with advanced breast cancers receiving chemotherapy. RESULTS: The response rates to anthracycline and taxane were 70.5% and 67.2%, respectively. Overall, 25.1% ± 29.7%, 8.32% ± 10.1%, and 16.37% ±17.5% of cancer cells in the tumors studied were positive for B-tub, TOP2A, and TIMP-1 expressions, respectively. However, positive molecule expression did not differ between patients who did and did not exhibit clinical responses to treatment. The proportion of TOP2A-positive cancer cells was significantly higher among anthracycline responders than among nonresponders in HR-negative cancer (15.4% ±17.5% vs. 2.0% ± 2.4%, respectively, P = 0.048), whereas TOP2A and TIMP-1 expression statuses did not differ in HR-positive cancer. When patients were stratified according to B-tub, TOP2A, or TIMP-1 expression statuses (B-tub ≥10% vs. <10%, TOP2A ≥5% vs. <5%, TIMP-1 ≤20% vs. >20%, respectively), the proportion of patients with ≥10% B-tub-positive cancer cells was significantly higher in taxane responders than in nonresponders (72.4% vs. 37.5%, respectively, P = 0.016). Anthracycline responders showed a trend to have a higher proportion of patients with either ≥5% TOP2A-positive cancer cells or ≤20% TIMP-1-positive cancer cells compared to nonresponders (86.7% vs. 61.5%, respectively, P = 0.066). CONCLUSION: Immunohistochemical TOP2A, TIMP-1, and B-tub expression analyses are expected to be useful for predicting tumor responses to chemotherapy.

[Extralobar pulmonary sequestration mimicking posterior mediastinal tumor].

The case was 13-year-old man. He visited local hospital due to high fever and back pain. He was diagnosed as acute pleuritis based on a chest computed tomography( CT) scan and referred to our hospital for treatment. Chest CT scan revealed a round shaped mass with clear margin at the left vertebrophrenic angle. A neurogenic posterior mediastinal tumor was suspected. Thoracoscopic surgery revealed that the mass had 2 thin string-like structures connecting to the descending aorta, and was suspected to be a pulmonary sequestration. The resected tumor was pathologically confirmed to be an extralobar pulmonary sequestration most of which was hemorrhagic necrosis caused by arterial infarction.

[Acute empyema with fistula successfully treated by curettage and endobronchial Watanabe spigot (EWS)].

A 49-year-old woman was referred to our hospital because of empyema. A chest drainage tube inserted and lavage performed. Her general condition improved but the infection and a major air leakage remained. On the 10th day after chest drainage, we performed thoracoscopic debridement and occlusion of bronchopleural fistulas using cellulose oxidized( Surgicel) and fibrin glue. Expansion of the lung and the improvement of inflammation were observed. but a major air leakage remained. On 29th postoperative day, we performed bronchial embolization using endobronchial Watanabe spigot (EWS). The leakage stopped the 7 days after bronchial embolization, we removed chest tube and 10 days after bronchial embolization she was discharged.

[Renal infarction and acute arterial obstruction of the lower extremity encountered after surgery for primary lung cancer].

The patient was 68-year-old who underwent left upper lobectomy and lymph node dissection. On the 4th postoperative day, he developed vomiting and lumbar pain. On 5th postoperative day, he complained of pain, sensory paralysis and cold sensation of the right lower extremity. Computed tomography(CT)examination revealed left renal infarction and acute arterial obstruction of the right common iliac artery. Emergency thrombectomy of the right lower extremity was performed. Postoperatively, he received anticoagulant therapy and was able to leave the hospital on the 20th postoperative day. Attention should be paid to the infarction of abdominal organs when developing abdominal symptoms after lung cancer surgery in elderly patients.

[Pleuroperitoneal communication detected at the beginning of continuous ambulatory peritoneal dialysis; report of a case].

A 61-year-old female was diagnosed as having end-stage renal failure developed dyspnea soon after introduction of continuous ambulatory peritoneal dialysis (CAPD). Chest X-ray showed a right-side massive pleural effusion. Pleuro peritoneal communication was suspicious, because the hydrothorax significantly improved by the stop of CAPD. We performed video-assisted thoracic surgery. Using indigo carmine containing peritoneal dialysis fluid through a CAPD catheter, we found a fistula on the diaphragm from which blue dialysis solution flowed out like a fountain. The fistula of the diaphragm was directly closed with a surgical stapler and covered using cellulose oxidized (Surgicel) and fibrin glue. She could restart CAPD on postoperative days 7, and no recurrence of hydrothorax has been detected for 10 months after surgical treatment.

Effect of mediastinal lymph nodes sampling in patients with clinical stage I non-small cell lung cancer.

OBJECTIVE: Systematic nodal dissection has been recommended for patients with resectable non-small cell lung cancer because of its staging accuracy. However, in patients with clinical stage I non-small cell lung cancer whether systematic nodal dissection provides more benefits than mediastinal lymph node sampling or not is controversial. In this retrospective study, we evaluated the effect of mediastinal lymph node sampling in patients with clinical stage I NSCLC. METHODS: One hundred and nineteen consecutive patients with clinical stage I NSCLC, who underwent curative operation between January 1994 and December 2000, were retrospectively reviewed (dissection group = 58: sampling group= 61). Systematic nodal dissection was defined as complete removal of mediastinal lymph node, and mediastinal lymph node sampling was defined as removal of lymph node levels 3, 4, and 7 for right-sided tumors and levels 5, 6, and 7 for left-sided tumors. RESULTS: The total number of removed mediastinal lymph nodes in patients who underwent systematic nodal dissection was 22.1 +/- 9.7, which was significantly higher than that in patients who underwent mediastinal lymph node sampling of 11.4 +/- 7.0 (p < 0.001). Postoperatively N2 disease was detected in 8 patients (13.8%) in the dissection group and 7 (11.5%) in the sampling group. After the median follow up of 79 months, the cancer specific survival rate at 5 year was 78.0% in the dissection group and 76.2% in the sampling group (p = 0.60). CONCLUSIONS: Mediastinal lymph node sampling showed the similar effect to systematic nodal dissection in patients with clinical stage I non-small cell lung cancer.