Thymofibrolipoma: a case report and review of the literature.

BACKGROUND: Thymofibrolipoma has been described as a variant of thymolipoma. To date, 3 cases have been reported, and the lesion have been described to consist of extensive areas of collagenous tissue interspersed with islands of mature adipose tissue and strands of thymic tissue. CASE PRESENTATION: A 43-year-old woman had an anterior mediastinal tumor. Macroscopically, the cut surface of the tumor was composed of a yellowish lipomatous component and a uniform whitish fibrous component with elastic stiffness. Microscopically, the tumor was composed of collagenous fibrous tissue with sparse spindle cells, mature adipocytes and strands or islands of thymic tissue. The spindle cells in the fibrous tissue had monoallelic deletion of the 13q14 region and corresponding loss of RB1 and FOXO1A protein expression. CONCLUSIONS: This case report may strengthen the hypothesis that thymofibrolipoma is a neoplastic lesion and a variant of thymolipoma and that thymofibrolipoma and lipofibroadenoma are different names for the same lesion. The name "lipofibroadenoma" was given to the lesion because of its histological resemblance to fibroadenoma of the mammary gland. However, this name does not reflect the pathogenesis of this lesion, and the name "thymofibrolipoma" would be preferable. It will be necessary to discuss whether lipofibroadenoma should be listed as an independent entity in the WHO classification.

Diffuse Alveolar Septal Amyloidosis With Wild-Type Transthyretin With Spontaneous Lung Hematoma.

We experienced a mass formation in the right lower lobe in a patient with cardiac amyloidosis and heart failure. Radiologic findings of the chest showed no abnormality except a mass. The patient had non-valvular atrial fibrillation and was taking edoxaban. Surgical resection of the mass revealed a hematoma. Further pathologic evaluation revealed diffuse alveolar septal amyloidosis with transthyretin (ATTR). The genetic testing found no mutation in the TTR gene. Therefore, systemic wild-type TTR amyloidosis (ATTRwt) was confirmed. Alveolar septal ATTRwt is rare and patient had alveolar septal ATTRwt with spontaneous lung hematoma.

[Thymoma showing enlargement and reduction in size with inflammatory events;report of a case].

An 87-year-old male who had gone surgery for bladder cancer in 1994, was pointed out a mass in the anterior mediastinum by follow up in May 2007. Thereafter, no change in size of the mass had been noted. In February 2011, however, enlargement of the tumor with inflammation and right pleural effusion was found. While waiting for surgery, the patient experienced regression of the tumor, and the pleural effusion disappeared. Tumor excision and combined resection of the lung and pericardium were performed. Postoperative histopathological findings showed Masaoka stageI thymoma of type B1 according to the World Health Organization( WHO) Classification. Granulation due to old inflammation, precipitation of cholesterin crystals, hemorrhages, and necrosis were noted in the tumor. In the differential diagnosis of tumors in the anterior mediastinum with spontaneous regression, thymoma should be considered.

Pulmonary pleomorphic carcinoma with rapid progression.

We describe a case of pleomorphic carcinoma showing a recurrent tumor with massive hemorrhage and myxoid change in the chest wall 2 months after complete resection. Whereas specimens from the initial surgery revealed both adenosquamous carcinoma and sarcomatous elements, the recurrent tumor predominantly consisted of a sarcomatous element. The recurrent tumor had stronger immunoreactivity for mesenchymal markers than the primary tumor, indicating that the sarcomatous element had more malignant potential than the epithelial element.

Predictive factors for postoperative acute exacerbation of interstitial pneumonia combined with lung cancer.

PURPOSE: Postoperative acute exacerbation (AE) of usual interstitial pneumonia (UIP) is a serious complication in the surgical treatment for primary lung cancer combined with UIP. The purpose of this study was to determine the predictors of AE of UIP after a major lung resection. METHODS: We retrospectively collected data for 40 patients who had been operated on for lung cancer and were diagnosed as UIP based on postoperative histopathological diagnosis. We then evaluated some predictive factors related to the AE of UIP. RESULTS: The incidence of postoperative AE of UIP was 15% (6/40 patients). No correlation between patients who developed AE of UIP and those who did not, in terms of preoperative C-reactive protein, white blood cell count, percentage lymphocytes, forced expiratory volume in 1 s, percentage total lung capacity, percentage diffusing capacity of lung for carbon monoxide, and the alveolar partial pressures of oxygen and carbon dioxide. Preoperative serum lactate dehydrogenase (LDH) and serum KL-6 were significantly higher and the percent vital capacity (%VC) was significantly lower in patients who developed AE of UIP than in those who did not. Furthermore, recursive descent partition analysis revealed that %VC (<80.6%) and LDH (>or=241 IU/l) could distinguish patients with AE from those without AE. CONCLUSION: Preoperative %VC plus serum LDH values were considered the predictive factors for AE of UIP after surgery for lung cancer.

A case of micronodular pneumocyte hyperplasia diagnosed through surgical resection.

Micronodular pneumocyte hyperplasia (MNPH) is often associated with tuberous sclerosis complex and/or lymphangioleiomyomatosis. We present the case of a 45-year-old woman with MNPH without evidence of either. A preoperative high-resolution chest computed topographic scan demonstrated a ground-glass opacity 8 mm in diameter that revealed the possibility of atypical adenomatous hyperplasia (AAH) or bronchioloalveolar carcinoma (BAC). Therefore an S3 segmentectomy of the right lung was performed, and the specimens revealed the characteristic histological and immunohistological features of MNPH. Solitary MNPH is extremely rare and requires to be distinguished from AAH or BAC on a computed tomographic scan; therefore surgical resection may be required to definitely rule out malignancy.

Intraoperative pleural lavage cytology after lung resection as an independent prognostic factor for staging lung cancer.

OBJECTIVE: Although malignant pleural effusion or dissemination is regarded as T4 per TNM classification of lung cancer, the prognostic significance in staging of pleural lavage cytologic examination remains undetermined. The purpose of this study was to clarify the utility of pleural lavage cytologic staging as a prognostic factor in patients with non-small cell lung cancer. METHODS: In 1271 patients with lung cancer who underwent curative resection, intraoperative pleural lavage cytologic examination was performed at thoracotomy (first cytologic examination), immediately after pulmonary resection and mediastinal lymph node dissection (second cytologic examination), and after last washing of pleural cavity (third cytologic examination). Positive first cytologic result represented cytologic positive result before lung resection; positive second and third cytologic results were regarded as cytologic positive results after lung resection. RESULTS: Eighty-nine patients (7.0%) had positive findings of pleural lavage cytologic examination before or after lung resection. Five-year survivals were 44.1% for patients with positive results before lung resection and 23.4% for patients with positive results after lung resection, both significantly worse than that for patients with negative results. Multivariate analyses revealed that positive lavage result after lung resection was an independent prognostic factor. We found significantly greater pleural recurrence among patients with positive pleural lavage cytologic results after lung resection than among those with negative results. CONCLUSIONS: In addition to TNM classification, results of pleural lavage cytologic examination after lung resection should be considered when staging non-small cell lung cancer. Adjuvant systemic therapy may improve outcome for patients with positive results.

Preoperative assessment of the pulmonary artery by three-dimensional computed tomography before video-assisted thoracic surgery lobectomy.

OBJECTIVE: Our aim was to evaluate the efficacy of 3D imaging using multidetector row helical computed tomography (MDCT) in the preoperative assessment of the branching pattern of pulmonary artery (PA) before complete video-assisted thoracoscopic lobectomy (complete VATS lobectomy) for lung cancer. METHODS: Forty-nine consecutive patients with clinical stage I lung cancer scheduled for complete VATS lobectomy were evaluated about branching pattern of PA on 16-channel MDCT. Intraoperative finding of the PA branching pattern were compared with the 3D-CT angiography images obtained using MDCT. RESULTS: According to the intraoperative findings, 95.2% (139 of 146) of PA branches were precisely identified on preoperative 3D-CT angiography. All of the seven undetected branches were within 2mm in diameter. There was not a case that needed conversion to open thoracotomy because of intraoperative bleeding. CONCLUSION: A 3D-CT angiography using MDCT clearly revealed individual anatomies of pulmonary artery and could play an important role in safely facilitating complete VATS lobectomy procedure. However, we were unable to detect several thin branches with this technique. So, more care should be taken to avoid bleeding from these small vessels.