Case of cutaneous botryomycosis in an 8-year-old immunocompetent boy with a review of the published work.

Botryomycosis is a rare chronic suppurative granulomatous infection caused by several genera of non-filamentous bacteria. The clinical and histopathological findings are similar to those of mycetoma caused by true fungi or aerobic actinomycetes. Botryomycosis is divided into cutaneous and visceral disease, with the cutaneous form being more common. Histopathology shows granules of etiologic bacteria called "sulfur granules". Botryomycosis occurs more commonly among immunocompromised patients, although some cases have also been reported in immunocompetent patients. We report the case of an 8-year-old immunocompetent boy who visited our hospital with a 4-mm diameter subcutaneous tumor with mild tenderness on his right heel for several months. We surgically removed the tumor with an initial diagnosis of epidermal cyst. Histopathology showed sulfur granules surrounded by an eosinophilic matrix, indicating the Splendore-Hoeppli phenomenon. The granules consisted of Gram-positive cocci, leading to a diagnosis of botryomycosis. The patient was successfully treated by excision and oral trimethoprim/sulfamethoxazole (240 mg b.i.d.) for 2 weeks as adjuvant therapy. No recurrence was noted following treatment. The subcutaneous tumor in this case was smaller than the typical in botryomycosis infections. We reviewed the infection duration and tumor size in reported cases of botryomycosis in immunocompetent patients. Small tumor size may suggest that the case is in an early stage; therefore, it is important to remove and investigate these lesions proactively.

New technique of percutaneous CT fluoroscopy-guided marking before video-assisted thoracoscopic surgery for small lung lesions: feasibility of using a 25-gauge needle without local anaesthesia.

OBJECTIVE: To retrospectively evaluate the feasibility of CT fluoroscopy-guided percutaneous marking using a 25-gauge needle and indigo carmine before video-assisted thoracoscopic surgery (VATS) for small lung lesions. METHODS: 21 patients, 14 males and 7 females, with a median age of 69 years (range, 40-79), underwent CT fluoroscopy-guided percutaneous VATS marking using a 25-gauge, 70-mm needle and 1.5-ml indigo carmine. The mean diameter of the lung lesions was 14 mm (range, 6-27). We evaluated the technical success rate, surgical success rate and complications related to this procedure by reviewing medical records and images. Technical success was defined as completion of this procedure. Surgical success was defined as resection of the target lesion with negative margins on pathological examination after VATS. Complications that required advanced levels of care were classified as major complications, and the remaining complications were considered minor. RESULTS: The technical success rate was 100%. In all cases, VATS was successfully performed as planned, and the target lesion was resected with negative margins on pathological examination after VATS. Thus, the surgical success rate was 100%. Mild pneumothorax was found in two cases, but further treatment was not required. The minor complication rate was 9.5% (2/21), and major complication rate was 0%. Only two patients (9.5%) complained of slight pain upon puncture, but local anaesthesia was not required. CONCLUSION: Percutaneous CT fluoroscopy-guided VATS marking using a 25-gauge needle without local anaesthesia appears feasible and safe. Advances in knowledge: This technique expands a possibility of the CT-guided marking.

Successful treatment of mucoepidermoid carcinoma in the left main bronchus.

Here, we report the successful treatment of a 40-year-old man with mucoepidermoid carcinoma that originated in the proximal end of the left main bronchus close to the carina. He underwent wide and deep airway wedge resection, including the distal trachea and part of the carina via left postero-lateral thoracotomy. He has demonstrated neither anatomic complications nor disease recurrence 2 years after the operation.

A case of chemoradiotherapy-associated cardiotoxicity that developed into acute heart failure with progressive subendocardial fibrosis.

We describe the case of a 61-year-old Japanese woman who developed acute heart failure 5 years after chemoradiotherapy for breast cancer. The patient received less than the cardiotoxic dose of docetaxel, epirubicin, cyclophosphamide, and fluorouracil and experienced no cardiovascular complications in the 5 years between the onset of chemoradiotherapy and the onset of acute heart failure. Cardiac catheterization was performed and elevation of end diastolic pressure of both ventricles was observed. Endomyocardial biopsy showed progressive replacement fibrosis in the subendocardium. Normal thickness of the right endocardium is <20 µm. Surprisingly, our patient had a fibrous subendocardium that was 100-200 µm thick. Ultrastructural abnormalities similar to those observed in anthracycline cardiotoxicity were evident on electron micrographs. This case report demonstrates the unique pathophysiology of heart failure in a patient who received less than the cardiotoxic dose of antineoplastic agents. Recent protocols have decreased the dosage of cardiotoxic agents; however, even these reduced doses might not be safe for all Japanese individuals and may cause subclinical cardiovascular damage and late-onset heart failure. Clinicians should monitor cancer survivors carefully, even if antineoplastic agents were administered under the cardiotoxic dose. .

[Incidence of string-like adhesion between thoracic wall and bullae observed during video-assisted thoracic surgery( VATS) for spontaneous pneumothorax].

It is not rare that string-like adhesion between lung apex and chest wall is observed during videoassisted thoracic surgery (VATS) for spontaneous pneumothorax. This adhesion may cause hemothorax which requires emergency operation, although the precise incidence of such cases is uncertain. We analyzed consecutive 120 spontaneous pneumothorax cases underwent VATS at Suzuka General Hospital from January 2005 to September 2008. Twenty-one out of 120 (17.5%) were such cases receiving partial resection of the lung including the adhesion after dividing it. Pathological study revealed the bullae close to the adhesion in all cases, suggesting that these adhesion caused after possible former pneumothorax. Thus, 21 cases might be recurrent pneumothorax. Even in clinically 1st onset pneumothorax, those cases may be good indication for VATS.

Multiple calcifying fibrous pseudotumors disseminated in the pleura.

Calcifying fibrous pseudotumor is an extremely rare benign lesion that develops in the pleura. We describe a case of multiple lesions in the pleura. The patient is a 52-year-old woman who had a subpleural mass on chest roentgenogram. The diagnosis was established by percutaneous needle biopsy. The largest tumor was hanging down from the parietal pleura, and additional small nodules were disseminated throughout the pleural cavity. Only a few tumors arising from the largest one were resected, and the others were left unresected. The resected tumors consisted of collagenous fibrous tissue, calcifications, and spindle cells that were positive only for vimentin immunostaining.

Isolation of LEM domain-containing 1, a novel testis-specific gene expressed in colorectal cancers.

Through analysis of genome-wide expression profiles on a cDNA microarray consisting of 23,040 human genes, we have been attempting to isolate novel molecular targets for diagnosis, treatment and prevention of colorectal carcinoma (CRC). Among the genes that were frequently transactivated in colorectal tumors, we identified a novel gene termed LEMD1 (LEM domain-containing 1) whose expression was elevated in 17 of 18 CRCs compared with their corresponding non-cancerous mucosae. Northern blotting revealed that LEMD1 was expressed only in testis among the 16 normal adult tissues examined. Subsequent analysis identified six alternatively spliced forms of the transcript in normal testis, but only one of them (656 nucleotides) was expressed in CRCs. Since the LEMD1 protein appears to fall in the category of cancer-testis antigens (CTAs), it may represent a promising target antigen for immunotherapy of CRCs.