[Anterior mediastinal mass with hyperthyroidism; report of a case].

The patient was a 27-year-old man who had been diagnosed as having hyperthyroidism and with an anterior mediastinal mass which was reduced in size after anti-thyroid therapy. This mass was thought to be thymic hyperplasia associated with hyperthyroidism. An anterior mediastinal mass accompanying hyperthyroidism should be surgically treated when it dose not regress after an appropriate antithyroid therapy or there is a clinical suspicion of malignancy.

[Two surgical cases of intrathoracic lipoma].

We experienced two cases of intrathoracic lipoma arising from the chest wall. The first case was a 55-year-old male, and another case was a 70-year-old female. In the second case, the computed tomography was highly suggestive of a pleural tumor with almost same density as the subcutaneous adipose tissue. This findings may be diagnostic in assessing intrathoracic chest wall type lipoma. Both cases had thoracotomy to remove the tumors. The tumors were easily resectable, though their capsules were partially unclear. We resected the tumors completely together with pleura, periosteum and intercostal muscle. The diagnosis of intramuscular lipoma was confirmed postoperatively by histopathologic examination in each case. When the capsule of lipoma is not clear, combined resection of the tumor and chest wall should be considered. There have been no recurrence of the tumors in our cases.

[A case report of asymptomatical large carinal bronchial cyst].

A 36-year-old man with a mediastinal bronchial cyst was reported. CT showed a mass with water density in the posterior mediastinum. MRI revealed that this mediastinal mass had high signal intensity on both T1-weighted and T2-weighted images. MRI was considered to be useful for the qualitative diagnosis of mediastinal tumors as cystic or solid. An operation was performed and histological diagnosis was bronchial cyst. Intracystic fluid study revealed high titer of total protein, amylase and tumor markers, low titer of glucose and LDH.

[Informed consent and surgical treatment in a 38-year-old female, Jehovah's witness with lung cancer].

A 38-year-old female was found to have abnormal lesion in the left lower lung by chest X-ray examination which was done for her periodical health examination in March, 1997. She was referred to our Institution for operation of the pulmonary lesion by her family physician. The pathology was reported to be adenocarcinoma by the preoperative bronchofiberscopy. As she was Jehovah's witness, she refused to receive either homologous or autologous blood transfusion on the ground of her faith. Prior to the operation, the consultation was held together with the patient, family and doctors in reference to the informed consent. In June, 1997, she had left lower lobectomy without blood transfusion. Postoperative course was uneventful. The problems of surgical treatment in Jehovah's witness rejected blood transfusion are discussed.

[A case of aneurysmal bone cyst arising from the left 4th rib].

We reported a case of aneurysmal bone cyst originating in the left 4th rib. This disease originating in a rib was recorded in only 18 cases in Japan in the literature. The patient was a 16-year-old man and he was first found to have an abnormal shadow in the left upper lung field on the chest roentgenogram. In this case, MRI was very useful to show internal septation of the tumor. We performed a thoracotomy through the left 4th intercostal space with an anteroaxillary skin incision and removed the tumor and the 4th rib completely. Pathological findings showed multiple cysts filled with blood and fibrous trabecullae containing osteoid tissue and multinucleated giant cells, confirming the diagnosis of aneurysmal bone cyst. There has been no evidence of recurrence during the 9 months postoperatively.

[A case of schwannoma arising in the brachial plexus with intrathoracic extension].

A case of benign schwannoma originating from the lowest trunk of the left brachial plexus with intrathoracic extension was reported. Intrathoracic growth of a schwannoma of the brachial plexus has been reported in only 3 cases in the literature. The patient was a 53-year-old man and he was first found to have an abnormal shadow at the left lung apex on the chest roentogenogram. We performed a thoracotomy through the left third intercostal space with an axillary skin incision and removed the tumor completely. There was no neurological problem postoperatively

[A case of synchronous double cancer in the same pulmonary lobe].

We have experienced a case of synchronous double cancer developing in the right lower lobe in a 75-year-old male. He was asymptomatic. His chest X-ray film showed two nodular shadows, one in the right proximal S8 and another in peripheral S9. The serum CEA level was elevated to 9.5 ng/ml. Bronchoscopic brush cytology revealed adenocarcinoma from the tumor in orifice of B8. He was therefore diagnosed preoperatively as having adenocarcinoma of the right S9 with metastasis to #12 hilar lymph node. Right lower lobectomy was performed. The final histological diagnosis was double primary lung cancer consisting of squamous cell carcinoma (S9) with rare mucoepidermoid carcinoma in the same lobe. His postoperative course was uneventful.