[Thoracoscopic Resection of Schwannoma Using Intraoperative Neurophysiological Monitoring: Report of a Case].

A 28-year-old right-handed woman had been diagnosed with a tumor of 30 mm in a diameter at the right first intercostal space adjacent to brachial nerve plexus. It was incidentally detected by medical checkup examination five years ago. Because the tumor enlarged to 36 mm in five years without any symptoms, thoracoscopic tumor resection was planned for diagnosis. Intraoperative neurophysiological monitoring (IONM) was performed to prevent brachial plexus nerve injury. The tumor was totally removed via thoracoscopic approach without postoperative neurological deficit. Histopathological diagnosis was schwannoma. In order to reduce the risk of neural injury, IONM is useful in thoracoscopic removal of the peripheral nerve tumor.

[Usefulness of Oxidization-regenerated Cellulose Sheets in Preventing Postoperative Adhesion Confirmed at Second Surgery for Lung Cancer].

The patient was a 42-year-old woman who had been found to have a mixed ground glass opacity in the lung on chest computed tomography, and had underwent right S6 segmentectomy. At surgery, the plain between the upper and lower lobe was covered with a regenerative oxidized cellulose membrane. Two years later, multiple small shadows appeared in the remaining right lower lobe and completion right lower lobectomy was performed by thoracoscopy due to the adhesion to the absence of adhesion. Both of the histological examinations confirmed the diagnosis of minimally invasive adenocarcinoma of the lung. An oxidization regenerated cellulose sheet was effective in preventing postoperative adhesion in pulmonary resection.

[Intrapulmonary hematoma masquerading as metastatic carcinoma of lung cancer].

We herein report a case of intrapulmonary hematoma after lobectomy for lung cancer. A 51-year-old male underwent right upper lobectomy for lung cancer in a thoracoscopic procedure. Three months after the operation, chest computed tomography showed a 16-mm well-circumscribed nodule in the right lower lobe suggesting metastatic carcinoma for lung cancer. We performed the partial resection of the right lower lobe. The histological examination confirmed the diagnosis of an intrapulmonary hematoma. When pulmonary shadow appears after lung operations, intrapulmonary hematoma is one of a choice of differential diagnosis. Magnetic resonance imaging may be useful in establishing the diagnosis when intrapulmonary hematoma is suspicious clinically.

Safe stapling technique for pulmonary vessels with the shortened introducers and curved tips in thoracoscopic surgery.

Endo GIA(™) curved tips with Tri-Stapler(™) is more useful for the approach for pulmonary vessels than conventional straight staplers. Unless adequate space is maintained below the vessels, there is a risk of causing damage to the back of vessels with the curved tip without optional introducers. The recommended method involves passing silk thread through the back of the pulmonary vessels and ligating the thread to the introducer. However, the long introducer often applies tension to pulmonary vessels and can be caught in the tissues surrounding vessels. Therefore, we devised a new method. First, the introducer is shortened to a length of approximately 3 cm and attached to a curved tip. Second, a Penrose drain is passed through the back of the vessels. Last, the introducer is inserted into the drain and the stapler is guided. The vessels can be cut without removing the introducers and Penrose drains from staplers.

[Malignant peripheral nerve sheath tumor causing hemothorax; report of a case].

We herein report a case of malignant peripheral nerve sheath tumor that caused a hemothorax. A 39-year-old male was found to have an abnormal shadow on a chest X-ray. Chest computed tomography showed a 60-mm tumor in the right posterior mediastinum. Fourteen months earlier, he underwent drainage of a hemothorax with a medaistinal tumor but refused to undergo further examinations. We performed a tumor resection combined with the right lower lobectomy and the partial resection of the pericardium because of invasion. The histological examination confirmed the diagnosis of a malignant peripheral nerve sheath tumor. Postoperative radiotherapy was performed. The patient has been well without recurrence for 9 months.

[Pulmonary mucosal associated lymphoid tissue( MALT) lymphoma with 7-year natural history; computed tomography( CT) scan findings and pathological correlations].

A 58-year-old man was found to have an abnormal shadow on chest computed tomography (CT). The size and density of the nodule increased gradually over 7 years. Partial lung resection was performed by a thoracoscopic procedure. The pathological examination and gene analysis revealed that the tumor was primary pulmonary B-cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma). The CT findings showed that the level of substantial shadow with air bronchograms gradually increased in the center of the mass shadow, while a radial filamentous and ground glass shadow increased in the periphery. The pathological findings showed a cellular lymphocytic infiltrate that had expanded without destroying the existing blood vessels and bronchi in the center area of the tumor, while had expanded in the interstitial area along with vessel bundles in the border area. The CT findings were consistent with the pathological findings.

A thymic cyst in the middle mediastinum: report of a case.

BACKGROUND: Thymic cysts are usually located in the neck or anterior mediastinal compartment. Thymic cysts arising in the middle mediastinum are extremely rare, with only 2 previously reported cases. We herein describe the third case of a thymic cyst in the middle mediastinum. CASE: A 41-year-old female was referred to our department because of an incidental mediastinal mass detected on chest X-ray. Computed tomography showed a well-defined 7 cm mass located in the retroinnominate vein area. Magnetic resonance imaging showed a cystic lesion without any soft tissue density in the circumference. The border of the tumor was clear, without any invasion and continuity with the surrounding tissue. We performed thoracoscopic surgery. After aspiration of the serous contents in an end-pouch, the tumor was removed from the thoracic cavity. A pathological examination showed a fibrotic cyst wall containing the thymic cyst, which diagnosed it as thymic cyst. CONCLUSION: Thymic cysts in the middle mediastinum are extremely rare. A surgical resection provided the histological diagnosis of a thymic cyst in the present case.

[Hyperbaric oxygen therapy for air embolism complicating computed tomography (CT)-guided needle marking of the lung].

Preoperative computed tomography( CT)-guided marking with a short hook wire for small sized lung tumors has become popular along with the spread of thoracoscopic surgery. Systemic arterial air embolism is a very rare but potentially fatal complication. The patient was a 79-year-old man who was found to have a mixed ground glass opacity shadow on chest CT. Almost immediately after marking, he lost consciousness and complete atrio-ventricular (AV) block was found on the electrocardiogram (ECG) monitor. Brain CT showed intravascular air bubbles in the right frontal lobe. Two hours later, his conscious level was recovered completely but remained left hemiplegia. Five hours later, he was transported to another hospital for hyperbaric oxygen therapy. After 3 episodes of the treatment, left hemiplegia recovered with slight sense disorder in the left little finger. When neurologic findings are remained after air embolism, hyperbaric oxygen therapy should be arranged immediately.

A case of sclerosing hemangioma forming a pedunculated mass.

We report our experience with an unusual case of sclerosing hemangioma (SH) that formed a pedunculated mass protruding into the thoracic cavity. A pulmonary tumor was found in a 60-year-old female during the medical examination. Computed tomography showed a 19 × 17-mm nodule with a clear border and smooth margin contiguous with the diaphragm in the right S8 segment. Uneven enhancement following contrast medium administration was observed. We performed a 3-port thoracoscopic wedge resection of the right lower lobe. We observed a yellow pedunculated tumor protruding from the diaphragmatic surface of the right lower lobe. The surface of the tumor was smooth and encapsulated. Microscopically, we diagnosed it as a SH. SHs usually exist adjacent to the visceral pleura, but rarely form pedunculated tumors protruding into the cavity as seen in this case. By thoracoscopic surgery, we successfully diagnosed and treated the patient in a minimally invasive manner. Since there have been reported cases of recurrence, we anticipate that periodic follow-up observations will be required.