[Ectopic Hilar Thymoma Associated with Morvan Syndrome after Extended Thymectomy for Myasthenia Gravis].

Morvan syndrome is a rare autoimmune neurological disease characterized by peripheral nerve hyperexcitability, autonomic dysfunction and encephalopathy. Morvan syndrome is often associated with thymoma as a paraneoplastic condition. Here we present a rare case of Morvan syndrome with ectopic hilar thymoma after extended thymectomy for myasthenia gravis.

[Metastatic Atypical Meningioma of the Lung;Report of a Case].

A 56-years-old woman, who had undergone a complete resection for atypical meningioma (grade 2 of World Health Organization classification)8 years before was admitted to our hospital to treat a mass on the right middle lobe detected by chest X-ray. The mass was resected successfully by video-assisted thoracoscopic surgery and pathological diagnosis of the tumor was a metastatic atypical meningioma. We experienced a rare case of extracranial pulmonary metastasis of meningioma. Grade 2 meningioma is thought to have malignant potential of local recurrence and extracranial metastasis compared to grade 1 meningioma, so long-term observation may be necessary after resection of atypical meningioma.

[Gastrointestinal Stromal Tumor with Metastasis of Chest Wall and Both Lungs].

A 60-years-old male, who had undergone surgery for gastrointestinal stromal tumor of small intestine 8 years before, was admitted to our hospital for surgical treatment of left 10th rib metastasis. Three months after the 1st operation new metastatic lesions appeared at hypodermic tissue at right anterior chest wall and left upper lobe of the lung and we performed 2nd operation to resect these lesions. Five months after 2nd operation, we performed 3rd operation to resect another metastatic pulmonary lesion at right upper lobe.

[Pulmonary Metastasis of Sacral Chordoma Fifteen Years after Resection of Primary Site;Report of a Case].

A 71-years-old man, who had undergone resection for sacral chordoma 15 years before, was admitted to our hospital to treat a nodule in the right middle lobe detected by computed tomography. The nodule was resected and was histologically diagnosed as lung-metastasis of chordoma.

[Metastatic Ovarian Granulosa Cell Tumor of the Diaphragm Resected by Video-assisted Thoracoscopic Surgery;Report of a Case].

A 75-years-old woman, who had undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy for ovarian granulosa cell tumor( OGCT) 6 years ago, was admitted to our hospital to treat a mass on the right diaphragm detected by computed tomography. The mass was resected successfully by video-assisted thoracoscopic surgery and pathological diagnosis of the tumor was a metastatic OGCT of the diaphragm. To our knowledge, this is the 3rd case report of metastatic OGCT of the diaphragm.

[Open Drainage for Mediastinitis after Endobronchial Ultrasonography-guided Transbronchial Needle Aspiration].

A 61-year-old man had been diagnosed as lung cancer (cT4N2M0, stage IIIB) and radiochemotherapy was performed. After the treatment, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was done to identify the histrogical type and to detect the oncogenic driver mutation. After EBUS-TBNA, he developed a high grade fever and the findings of the chest computed tomography (CT) suggested the infection of puncture site in mediastinum. Symptoms disappeared once by oral and intravenous antibiotics, but the infection recurred again. Chest CT revealed an abscess cavity with possible communication to the airway. Open drainage and debridment were performed and the anticancer chemotherapy could be continued.

[Rib Metastasis from Intracranial Hemangiopericytoma: Report of a Case].

A 65-year-old man had undergone the surgical treatment for intracranial hemangiopericytoma(HPC) in 2011. In June 2013, the X-ray abnormality in health examination was pointed out. Chest Computed tomography shows a 30 mm-sized tumor lesion with bone destruction in the 6th left rib bone. Fluorodeoxyglucose-positron emission tomography revealed no lesion except for the tumor. Surgical resection of the rib tumor was performed in July 2013. Pathologically it was diagnosed as bone metastasis of HPC. The postoperative course was uneventful, but multiple bone metastases were found 6 months after surgery.

[Solitary Mediastinal Lymph Node Metastasis From Hepatocellular Carcinoma].

A 40-years-old Japanese female suffering from misswallowing and hoarseness, who had undergone hepatectomy due to hepatocellular carcinoma(HCC) 4 years before, revealed solitary subaortic mass in the chest computed tomography scan and fluorodeoxyglucose-positron emission tomography. The mass was surgically resected by video assisted thoracoscopic surgery and pathological examination revealed lymph node metastasis of HCC. Symptoms of recurrent nerve palsy disappeared after surgery.

[Subpectoral lipoma developing to cervix; report of a case].

A 54-year-old Japanese female, who presented slight swelling of the supraclavicular region due to soft indolent mass without neurological impairment, was admitted to our hospital to receive surgical treatment. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed subpectoral mass surrounded by the minor pectoral muscle, the subscaplar muscle, and the bony thorax, and spread to cervix passing through between the right clavicle and the bony thorax, indicating similarity of the intensity and the density to subcutaneous fatty tissue, and then the mass was guessed to be extremely rare subpectoral lipoma. The lipoma was dissected successfully from adjacent subclavian artery and vein, brachial nerve, and surrounding muscles through sub-and supra-clavicular small skin incision without cut of the clavicle. Subpectoral lipoma is one of the benign tumor and at the operation less invasive and cosmetically superior approach should be adopted except for inevitable cases.

Phase II study of carboplatin and weekly paclitaxel combination chemotherapy in advanced non-small cell lung cancer: a Kansai Clinical Oncology Group study.

The objective of this phase II study was to evaluate the efficacy and toxicity of carboplatin and weekly paclitaxel combination chemotherapy in previously untreated, advanced non-small cell lung cancer (NSCLC). Patients received paclitaxel at a dose of 70 mg/m(2) on days 1, 8, 15, and carboplatin with the target dose of area under the curve (AUC) of 6 on day 1 every 28 days. Forty-six patients were enrolled. A median of four cycles (range, 1-13) were administered. Complete response was observed in one patient (2.2%) and partial response in 23 patients (50%), yielding an overall intent-to-treat response rate of 52.2% (95% confidence interval, 37.8-66.6%). The median survival time was 395 days and 1-year survival rate was 51.4%. Toxicities were mild. Twelve patients (26%) had grade 3 and three patients (7%) had grade 4 neutropenia. Grade 3 thrombocytopenia was seen in four patients (8%). Massive hematoemesis due to duodenal ulcer was observed in one patient, but no other patients experienced grade 3 or more non-hematological toxicities. There was no treatment-related death. Carboplatin and weekly paclitaxel combination chemotherapy is an efficacious and feasible regimen in patients with advanced NSCLC, and this treatment will be a reasonable alternative to the conventional triweekly regimen of paclitaxel and carboplatin.

Malignant peripheral nerve sheath tumor of small round cell type with pleomorphic spindle cell sarcomatous areas.

An unusual case of malignant peripheral nerve sheath tumor (MPNST) arising in the posterior mediastinum of a 59-year-old man is reported. Histopathologically, the tumor showed an admixture of a dense proliferation of small round cells resembling a primitive neuroectodermal tumor (PNET) and a pleomorphic spindle cell sarcomatous area. Abortive rosettes, primitive neural tube-like structures, and a few glandular structures were found in the small round cell area. Small round cells were immunoreactive for neural cell adhesion molecule and synaptophysin, but were not immunoreactive for MIC2 and neuron-specific enolase. Pleomorphic spindle cells were occasionally arranged in a storiform pattern and were diffusely immunoreactive for S-100 protein. The MPNST of small round cell type is distinguishable from PNET by its negative immunoreactivity for MIC2, and the present tumor is assumed to be derived from primitive neuroectodermal cells in the peripheral nerve capable of bidirectional (neuron and Schwann cell) differentiation.

Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment.

OBJECTIVE: The purpose of this study was to analyze our entire experience with pulmonary resection for metastatic colorectal carcinoma to determine prognostic factors and critically evaluate the potential role of extended metastasectomy. METHODS: We analyzed the postoperative survival of 165 patients who underwent curative pulmonary surgery at eight institutions in the Kansai region of western Japan (Kansai Clinical Oncology Group) from 1990 to 2000. RESULTS: Overall survivals at 5 and 10 years were 39.6% and 37.2%, respectively. Cumulative survival of patients who underwent simultaneous bilateral metastasectomy was significantly lower than that of the patients who underwent unilateral metastasectomy or sequential bilateral metastasectomy (P =.048). Five-year survival was 53.6% for patients without hilar or mediastinal lymph node metastasis, versus 6.2% at 4 years for patients with metastases (P <.001). Five-year survival of patients with a prethoracotomy carcinoembryonic antigen level less than 10 ng/mL was 42.7%, versus 15.1% at 4 years for patients with a carcinoembryonic antigen level 10 ng/mL or greater (P <.0001). Twenty-one patients underwent a second or third thoracotomy for recurrent colorectal carcinoma. Overall 5-year survival from the date of the second thoracotomy was 52.1%. The 34.1% 10-year survival for the 26 patients with hepatic metastasis resected before thoracotomy did not differ significantly from that of patients without hepatic metastases (P =.38). CONCLUSIONS: The status of the hilar or mediastinal lymph nodes and prethoracotomy carcinoembryonic antigen level were significant independent prognostic factors. Patients with pulmonary metastases potentially benefit from pulmonary metastasectomy even when there is a history of solitary liver metastasis. Careful follow-up is warranted, because patients with recurrent pulmonary metastases can undergo repeat thoracotomy with acceptable long-term survival. Simultaneous bilateral metastasectomy confers no survival benefit. Prospective studies may determine the significance of this type of pulmonary metastasectomy.