[Acquired Bronchial Atresia due to Endobronchial Tuberculosis].

A 37-year-old woman was re-admitted to our hospital because the recurrence of endobronchial tuberclosis was suspected. Mycobacterium tuberculosis was not detected by culture of sputum and gastric fluid, and computed tomography revealed a left superior segmental bronchus obstruction and pneumonia. Her pneumonia improved by administration of antibiotics, but the strong cough persisted. Bronchoscopic examination revealed that the left superior segmental bronchus was blind. Mycobacterium tuberculosis was not detected from a biopsy of the blind bronchus wall. We diagnosed that her obstructive pneumonia was due to acquired atresia after endobronchial tuberculosis. Because a persistent cough even after the treatment of pneumonia indicated the possibility of recurrent obstructive pneumonia, surgical resection was performed. The postoperative course was uneventful and the patient was discharged on the 8th postoperative day. The atresia of the superior segmental bronchus was histologically considered to be acquired atresia due to the inflammation from tuberculosis.

Resection of a ruptured mature cystic teratoma diagnosed two years after the onset of perforation.

Perforated cystic teratomas are rare. Our patient was a 16-year-old female who presented with severe chest pain two years ago. A right-sided pleural effusion was accidentally detected by chest radiography performed at her school. Computed tomography revealed a high density area with multiple small, thickened, lobulated lesions and a low density area with pleural effusion adjacent to a thinned wall. Pathognomonic inhomogeneous computed tomography findings led to an accurate diagnosis of a mature teratoma that had ruptured long before presentation. Thoracoscopic resection was performed, and the final histological diagnosis was a mature teratoma with partial rupture.

Benign myoepithelioma in the intrathoracic trachea.

A 67-year-old woman who was followed as a patient with bronchial asthma for 1.5 years visited our hospital with progressive dyspnea. Although the chest radiography findings were normal, a chest computed tomography scan revealed a mass obliterating the intrathoracic tracheal lumen. The patient's symptoms disappeared immediately after tumor excision, and no recurrence was observed during a 1.5-year follow-up period. Microscopically, the tumor was composed of densely packed polygonal-, oval- and spindle-shaped cells that were positive for pan-cytokeratin, α-smooth muscle actin and p63. These pathological findings confirmed the diagnosis of benign myoepithelioma. Chest physicians should recognize that benign myoepithelioma can develop in the trachea, although it is very rare.

[Mediastinal lymph node carcinoma of unknown primary site; report of a case].

We experienced a rare case of a 38-year-old man with mediastinal lymph node carcinoma of unknown primary site. He had an abnormal shadow of upper mediastinal mass in a health check, and he was referred to our hospital. Chest computed tomography( CT) showed only one swollen mediastinal lymph node, and positron emission tomography(PET) revealed an accumulation of fluorodeoxyglucose in the nodule. Serum levels of neuron specific enolase (NSE) were found to be elevated. Preoperative examination did not detect the primary lesion. She underwent a mediastinal lymphadenectomy. The pathological diagnosis of the lesion was large cell neuroendocrine carcinoma. He was given platinum-based combined chemotherapy and radiotherapy as adjuvant therapy. He has been well without any sign of recurrence for 1 year after surgery. Surgical resection of mediastinal lymph node carcinoma of unknown primary site has the possibility of a good prognosis.

[Giant hemangioma of the rib].

We experienced a rare case of a 73-year-old woman with giant hemangioma of the left 8th rib. She had an abnormal shadow of left lower lung field in a health check and was referred to our hospital. Preoperative examination suggested malignant rib tumor because of tumor growth beyond the disrupted bony cortex. She underwent resection of the left 8th rib with the 7th rib and the 7th intercostal muscles and reconstruction of the chest wall defect. The pathological diagnosis of the lesion was cavernous hemangioma. She was discharged after an uneventful postoperative course. She has been well without any sign of recurrence for 3 year after surgery.

[Pulmonary mycobacterium intracellulare infection complicated with pneumothorax and chronic empyema].

A 75-year-old woman who had been treated for pulmonary Mycobacterium intracellulare infection was admitted to a nearby hospital because of hemoptysis, right pneumothorax, and empyema. She had been treated by thoracic drainage and pleural lavage, but was reffered to our hospital because of refractory empyema. Her chest radiograph and chest computed tomography( CT) showed right chronic empyema of which pleural aspirate was smear positive for acid-fast bacilli and positive for the polymerase chain reaction method(PCR)-Mycobacterium intracellulare. Serum levels of white blood cell and C-reactive protein(CRP) were found to be slightly elevated. She was treated with combined use of ethambutol, rifampicin, clarithromycin, and kanamycin and with pleural curettage by thoracoscopic surgery. After surgery additional treatment was done using urokinase which was administered into the thoracic cavity via an thoracic tube. Chronic empyema gradually improved with the treatment and the pleural effusion became bacterial free, enabling the patient to discharge from hospital without thoracic drainage.

[Atypical thymic carcinoid with hypercalcemia].

We experienced a rare case of a 76-year-old man with an anterior mediastinal tumor diagnosed postoperatively as atypical thymic carcinoid with hypercalcemia. He was found to have a growing abnormal mediastinal shadow, and admitted. Chest computed tomography scan on admission revealed an anterior mediastinal mass of 4.0 cm in diameter. Extended total thymectomy was performed through a median sternotomy. The histopathological diagnosis was an atypical carcinoid of the thymus. He received adjuvant mediastinal irradiation. Endocrinological tests for preoperative hypercalcemia revealed high levels of serum intact-parathyroid hormone( PTH), prolactin and gastrin. A parathyroid scintigraphy revealed a parathyroid tumor. He has been well without any sign of recurrence for 1 year after surgery and irradiation treatment. When diagnosing anterior mediastinal tumor with hypercalcemia, atypical carcinoid of thymus with hyperparathyroidism should be considered.

[Chest wall lipoma mimicking a well differentiated liposarcoma; report of two cases].

We experienced 2 cases of chest wall lipoma mimicking a well differentiated liposarcoma. The 1st case was a 60-year-old female. She admitted to our hospital with abnormal shadow detected by chest X-ray. Positron emission tomography combined with computed tomography (PET-CT) revealed fatty tumor penetrating left chest wall without significant accumulation of fluoro-2-deoxy-D-glucose (FDG). Resection of the tumor with partial resection of the 6th and 7th ribs with were performed, because the tumor was suspected to invade surrounding tissues by surgical findings. The other case was a 41-year-old male. He admitted to our hospital with abnormal shadow detected by chest X-ray. PET-CT revealed fatty tumor penetrating left chest wall and its standard uptake value (SUV) was 1.2. The tumor was resected with surrounding periosteum and intercostal muscle without thoracotomy. Both cases were diagnosed as lipoma by pathology.

The effects of immediate enteral feeding with a formula containing high levels of omega-3 fatty acids in patients after surgery for esophageal cancer.

BACKGROUND: We investigated whether supplementation of enteral nutrition (EN) with omega-3 polyunsaturated acids (PUFAs) affected platelet aggregation, coagulation activity, and inflammatory response in the early stages after esophageal cancer surgery. METHODS: Twenty-eight patients with esophageal cancer who underwent the same surgical procedure were selected for this study. All patients received EN, which was started immediately after the operation and was increased to a maximum volume of 1500 ml/day by the third postoperative day (POD). Eleven patients received a conventional EN formula (Ensure Liquid), while the remaining 17 patients received a different formula rich in omega-3 PUFAs (Racol [RAC]). Several markers of coagulation and fibrinolysis were determined in POD 2, while the concentrations of interleukin (IL)-6, IL-8, 6-keto-PGF1alpha and thromboxane B2 were determined on PODs 1, 3, and 5. RESULTS: A total of 27 patients completed the study, 11 in the Ensure Liquid group and 16 in the RAC group. Administration of RAC significantly inhibited the postoperative decrease in platelet count. The level of D-dimer was attenuated significantly in the RAC group. Plasma IL-8 levels were decreased significantly in the RAC group on PODs 1 and 3. The anti-inflammatory effects of omega-3 PUFAs were confirmed by the clinical findings of lower body temperature. The plasma concentration of 6-keto-PFG1alpha also tended to decrease in the RAC group with a significant difference on POD 5. CONCLUSIONS: Early EN with a large amount of omega-3 PUFAs in reduced platelet aggregation, coagulation activity, and cytokine production. All these effects would be expected to be beneficial in patients following esophageal cancer surgery. The clinical significance of the changes in eicosanoid production remains to be established.