Lung cancer associated with pulmonary bulla. case report and review of literature.

A few reports have suggested the possible association between lung cancer and bullous disease. We report a surgical case of lung adenocarcinoma located in close proximity to pulmonary bullae. A 48-year-old nonsmoker, asymptomatic male was found to have a pulmonary tumor mass and giant bulla in the right lung. Thoracotomy identified a tumor arising from a firm, scarred and contracted area close to the bulla wall. Based on this report and review of other cases in the literature, we emphasize the need for physicians to be aware of the potential development of lung cancer in patients with pulmonary bulla.

Benign asbestos pleural effusion associated with pulmonary aspergilloma.

A rare case of benign asbestos pleural effusion associated with aspergilloma is reported. A chest radiograph of a 75-year-old Japanese man who was admitted with right chest pain showed a right pleural effusion and nodular shadows in the right apex and left middle lung field. Thoracocentesis revealed an exudate with atypical mesothelial cells. An open lung biopsy showed aspergilloma in the right S2 area and no evidence of malignancy. Many reactive mesothelial cells were found in the pleura. A quantitative asbestos digestion study of the lung tissue biopsy showed high-grade asbestos exposure.

Two familial mesothelioma cases with high concentrations of soluble cytokeratin 19 fragment in pleural fluid.

We report two cases of diffuse malignant pleural mesothelioma occurring almost simultaneously in one family. Patient 1 was a 42-year-old Japanese man who had worked as an electrical engineer for 25 years. Patient 2, his mother, was 69 years old. She lived for 10 years with patient 1 after he started his work, and also worked at a shipyard herself for 6 years. The concentrations of cytokeratin subunit 19 fragment (CYFRA 21-1) in pleural fluid of the two patients were 1,500 ng/ml, and 1,200 ng/ml, respectively. Measurement of CYFRA 21-1 concentration in the pleural fluid may be a useful tool for a diagnosis of malignant mesothelioma.

[A case of benign cystic teratoma growing in the thoracic cavity].

A case with benign cystic teratoma growing in the thoracic cavity, which is rare in Japan, in a 49-year-old woman is reported. She complained a chest pain suddenly. Chest X-ray examination revealed an abnormal shadow and pleural effusion in the right lung field. Chest CT scan and MRI disclosed a capsulated tumor in the thoracic cavity. During surgery the tumor had adhered to the part of the parietal pleura with no continuity with anterior mediastinum. The tumor measured 11.0 x 9.5 cm in size and was a mature cystic teratoma with pancreatic tissue, histologically. The fluid levels of amylase extracted from the tumor was highly elevated. Rupture due to autodigestion by pancreatic amylase of the tumor was supposed to be a cause of chest pain.

Congenital tracheoesophageal fistula with symptoms commencing at the onset of trauma: report of a case.

Congenital tracheoesophageal fistula without atresia can persist and remain undetected without symptoms until adulthood. We have recently encountered such a rare case and also conducted a review of the literature. Symptoms are commonly present during infancy, but occasionally patients do not develop symptoms until adulthood. In this case, it is suggested that the symptoms commenced after the redundant mucosal flap or membrane was broken due to a trauma to the chest.

[A case of chondrosarcoma of the low grade malignancy originated in rib].

A case with chondrosarcoma of rib, which is relatively uncommon in Japan, in a 61-year-old man is reported. Chest X-ray examination revealed an abnormal shadow in the right of the chest wall. Chest CT scan and MRI disclosed the tumor to have been arosen from the right 5th rib protruding into the thoracic cavity. Surgical resections of the tumor with parts of the 4th and 5th ribs and parietal pleura were performed. The defect of the chest wall was repaired with muscle. The tumor measured 3.0 x 3.0 x 3.5 cm in size and was a chondrosarcoma of the low grade malignancy, histologically. Post operative course was uneventful with no adjuvant therapy.

Fibrolipomatous hamartoma of the lung: a case report and review of the literature.

A fibrolipomatous hamartoma of the lung in a 57-year-old Japanese man is reported. Computed tomography revealed an abnormal mass with fatty and soft tissue densities in the upper portion of the right lung, indicating a liposarcoma. Upon resection, the tumor was found to consist of a 7.5 x 4.0 cm soft, yellowish mass continuous with a 3.0 x 1.5 cm polyp. The tumor was composed primarily of mature fibro-adipose tissue with some glandular and cartilaginous components, which identified it as a fibrolipomatous hamartoma. Follow-up studies of the patient for two years after surgery found no sign of malignancy. Thus, lipomatous or fibrolipomatous hamartoma should be considered as a possible diagnosis whenever atypical lipomatous lung tumors are encountered.

[A case of coronary artery to pulmonary artery fistula associated with impending rupture of saccular aneurysm].

The patient was a 65-year-old woman who was admitted for chest oppression and back pain. Coronary angiography showed an abnormal artery originating from the right coronary artery with the formation of two saccular aneurysms, and draining into the pulmonary artery. The abnormal artery and the aneurysms were resected, and the pulmonary artery was sutured under cardiopulmonary bypass, successfully.

Glomus tumor of the trachea. Immunohistochemical and electron microscopic studies.

Glomus tumor of the trachea which developed in a 51-year-old man was reported. He experienced frequent episodes of respiratory infections and hemoptosis for 9 months. Bronchofiberscopic study demonstrated a polypoid tumor in the upper trachea. Local resection of the tumor was performed and it arised from the membranous portion of the third and fourth tracheal rings. Histologically, the tumor was composed of medium-sized rounded cells, resembling carcinoid tumor. Desmin and myosin immunoreactivities were found in most of the tumor cells. Electron microscopic examination showed that the tumor cells contained fine filaments with focal density, numerous pinocytotic vesicles along the plasma membrane and abundant mitochondria. The patient is well without evidences of tumor recurrence 2 years after the resection. This is the fourth report of the tracheal glomus tumor with definitive evidences of smooth muscle differentiation of the tumor cells.

[Surgical treatment for thoracoabdominal and suprarenal abdominal aortic aneurysm].

We experienced 4 cases of thoracoabdominal and suprarenal abdominal aortic aneurysm in the last 6 months. There were 3 males and 1 female ranging in age from 43 to 66 years, 2 with an etiology of aortitis syndrome, 1 with non-specific inflammation and 1 with atherosclerosis. In all cases the modified Hardy procedure was employed. A 18 to 22mm X 9 to 11mm bifurcation, double velour woven dacron graft was sutured from the side of the lower descending thoracic aorta to the side of both common iliac arteries. Grafts of the same kind as above 6 to 7mm in size were attached from the main graft to major visceral arteries by end-to-end or end-to-side anastomosis. A permanent aortic-excluding clamp was attached to the normal aorta just proximal to the aneurysm. Another clamp, or double ligature with silk, was placed on the lower abdominal aorta or both common iliac arteries distal to the aneurysm. No renal and spinal preservation of any kind was employed, but renal failure and paraplegia were not recognized in any of the cases. One patient died 2 days and another 21 days after the operation due to uncontrollable bleeding and multiple organ failure. The other two are doing well.