Cavernous hemangioma arising from the diaphragm.

A 51-year-old man was referred to our hospital with an abnormal nodule in the right lung field. Computed tomography revealed a homogeneous nodule adjacent to the diaphragm, which appeared to be an extrapulmonary lesion. No hilar or mediastinal lymph node swelling was detected, and positron-emission tomography showed no significant uptake. At surgery, 2 red papillary tumors were found, originating from the right diaphragm, and tumor extirpation was performed. The pathological diagnosis was cavernous hemangioma.

[Invasive pulmonary aspergillosis with hemoptysis; a resected case whose bleeding point is detected pathologically].

A 55-year-old man, who presented with recurrent episodes of hemoptysis, was referred to our hospital under the diagnosis of invasive aspergillosis with a cavity in the right lung. Computed tomography showed a large thick-walled cavity in the right upper lung. He underwent right upper lobectomy. Pathological findings showed a large cavity in right upper lobe. Aspergillus was found in the cavity. A pseudoaneurysm, which was thought to be a cause of hemoptysis, originated from a ruptured pulmonary artery and protruded into the cavity. Hemoptysis is well-known symptom in aspergillosis patients, and surgery for aspergillosis with hemoptysis is sometimes performed. But it is very rare that bleeding point is detected microscopically.

[Malignant lymphoma of lung with hypersensitivity pneumonitis].

We report a resected case of malignant lymphoma with hypersensitivity pneumonitis. A 62-year-old woman, who presented with fever, wheeze and dry cough was referred to our department under the diagnosis of malignant B cell lymphoma in lower lobe of the left lung and hypersensitivity pneumonitis. She underwent left lower lobectomy as a therapy for malignant lymphoma. Pathological findings showed multiple small nodules macroscopically, which was observed as bronchiolocentric interstitial pneumonitis with lymphocytes microscopically. Post operative course was uneventful and no sign of acute exacerbation was seen. It is rare that lung with hypersensitivity pneumonitis is observed as a macroscopical specimen. Hypersensitivity pneumonitis differs from idiopathic pulmonary fibrosis, but we have to take care of post operative course because post operative acute exacerbation was reported.

Combined typical carcinoid and acinic cell tumor of the lung.

We report a case of combined typical carcinoid and acinic cell tumor of the lung in a 55-year-old female. A chest radiograph revealed an abnormal shadow. Computed tomography (CT) showed a tumor in the S3 segment of the right lung. The transbronchial biopsy yielded a diagnosis of non-small-cell lung cancer. Radical surgery was performed. The pathological diagnosis was combined typical carcinoid and acinic cell tumor of the right lung. This is third case of this tumor which has been reported.

Thoracoscopic surgery for pulmonary arteriovenous malformation.

We report 6 consecutive cases of pulmonary arteriovenous malformation in the periphery of the lung, which were treated successfully by thoracoscopy. Pulmonary wedge resection was performed with a linear cutting stapler to divide the feeding artery, drainage vein, and aneurysmal lesion of the arteriovenous malformation. Operative time ranged from 30 to 95 min (mean, 50 min). Bleeding was minimal in all cases. No major surgery-related complications were observed. Postoperative hospital stay was limited to one week except for one patient who had experienced a brain infarction preoperatively, caused by migration of an embolization coil. Histological examination confirmed that the arteriovenous malformation foci were completely removed. Pulmonary wedge resection through thoracoscopy is feasible as an alternative treatment for arteriovenous malformation located in the periphery of the lung parenchyma when pulmonary embolization therapy is difficult or unsuccessful.

Appraisal of surgical treatment for pulmonary metastasis from hepatocellular carcinoma.

The outcome of pulmonary metastasectomy of hepatocellular carcinoma (HCC) was appraised in this study. Twenty patients with pulmonary metastasis from HCCs undergoing pulmonary resection between 1990 and 2003 were included in this study. They had undergone curative treatment for the primary lesion and were candidates for a pulmonary metastasectomy for complete resection. Among the 20 patients, 13 died: 5 from hepatic failure, 5 from respiratory failure, and 2 from brain metastasis due to recurrence of the HCC. One patient died from cardiac failure without HCC recurrence. At the latest observation, three of the seven survivors were doing well without HCC recurrence, and others survived with recurrence. The overall survival rates after the initial lung surgery were 45.3% at 1 year and 23.8% at 3 years, respectively. The survival rates without recurrence were 32.4% at 1 year and 21.6% at 3 years, respectively. A Kaplan-Meier analysis showed that multiple lung surgeries and a negative histologic finding of the liver cut surface were favorable characteristics for survival without recurrence. In conclusion, the selected patients were Candidates for pulmonary metastasectomy after a curative hepatectomy for HCC and could benefit from the complete resection. Also, repeated pulmonary resections through thoracoscopy could result in the long-term survival of patients with pulmonary recurrence of HCC.

Rearrangement of T-cell receptor beta and gamma genes in thymoma.

To investigate the differentiation stage of tumor-infiltrating lymphocytes in thymoma tissue, we performed Southern blot analysis of T-cell receptor beta and gamma genes in thymomas resected from 19 patients. At the same time, we conducted flow cytometric analysis of T-cell surface markers and examined the clinicopathological features of the thymomas. We found that the incidence of T-cell receptor gamma gene rearrangement was significantly higher in Masaoka stage I thymomas (11 of 12 cases) than in stage II or III invasive thymomas (3 of 7 cases). Moreover, gamma gene rearrangement was observed in all 10 type AB and B1 thymoma specimens and in 4 of 6 type B2 thymoma specimens. The 2 specimens of type B3 thymomas, which were classified as stage III, showed neither gamma nor beta gene arrangement and were single-positive for CD4 or CD8. Six thymoma specimens that showed beta gene rearrangement expressed both CD4 and CD8. In conclusion, thymomas have the capability of T-lineage cell differentiation, except for a subset of invasive thymomas with malignant characteristics.

Coccidioidomycosis of the lung contracted abroad.

Coccidioides immitis is endemic in the southwestern United States. Coccidioidomycosis is rare in Japan, but the number of coccidioidomycosis cases from overseas is expected to increase markedly in the near future. A 33-year-old Japanese man with coccidioidomycosis who had lived in Arizona presented to our hospital. We performed wedge resection of the lung by video-assisted thoracoscopic surgery (VATS), and were able to completely remove the lesion. VATS wedge resection of the lung is effective in treating localized coccidioidomycosis. Before the operation, we could not confirm the existence of satellite lesions, but microscopically the main lesion was accompanied by several daughter lesions. It is very important that the surgical margin be sufficient to achieve complete resection.

Effect of preoperative transbronchial biopsy on prognosis of non-small cell lung cancer.

The aim of this study was to examine the hypothesis that post-surgical prognosis of patients with non-small cell lung cancer (NSCLC) proven by preoperative transbronchial biopsy (TBLB) was inferior to that of patients with NSCLC determined at time of surgery. Patients with NSCLC undergoing complete resection were divided into two groups. Group 1: pathologic diagnosis determined by TBLB consisting of 335 cases, and Group 2 where TBLB was unsuccessful and exploratory thoracotomy or thoracoscopy was followed by surgical resection, consisting of 186 cases. The post-surgical recurrence-free rate and survival rate were significantly higher in Group 2 than Group 1. Recurrence-free survival rate of stage IA patients in Group 2 (93 cases) was also significantly higher than that of stage IA Group 1 patients (70 cases) (p = 0.0018). Multivariate analyses demonstrated that positive TBLB yield was an independent negative determinant of prognosis in addition to pathologic staging and other clinicopathological factors. In conclusion, post-surgical prognosis of NSCLC patients was superior if preoperative TBLB was unsuccessful. This result suggested that advanced NSCLC had a tendency to be diagnosed with TBLB, and that the TBLB procedure might negatively impact the prognosis of patients with resectable NSCLC.

Parathyroid adenoma manifested by mediastinal hemorrhage: report of a case.

Acute mediastinal hemorrhage is rarely caused by a rupture of mediastinal neoplasms. We herein report a 70-year-old man who presented with mediastinal parathyroid adenoma manifested by the sudden onset of mediastinal bleeding. Preoperatively, he showed no symptoms or complications associated with hypercalcemia. No particular findings were found in the thorax except for a small nodule in the upper mediastinum. The nodule was resected through a collar incision, and pathohistology showed a parathyroid adenoma, with an intracapsular hemorrhage.