A case of mediastinal teratoma discovered availing of pneumonia

A 42-year-old woman was admitted to our hospital with hemosputum and an abnormal shadow on chest X-ray. Although her hemosputum disappeared after the treatment of pneumonia, the abnormal shadow was not improved. Chest CT showed a mediastinal mass. She underwent thoracotomy and the tumor, measuring 6 x 5 x 5 cm in size, was resected. Pathological diagnosis was a mature type teratoma with direct invasion to the lung. We have to take mediastinal teratoma into consideration as one of the causes of pneumonia.     

A case of esophageal cyst resected by thoracoscopic surgery

A 59-year-old woman was admitted with back pain and an abnormal chest shadow in the left hilar region. Her chest CT scan showed a posterior mediastinal mass surrounding the descending aorta. By transesophageal ultrasonography, a diagnosis of mediastinal cyst was made. She underwent thoracoscopic resection under general anesthesia with new endoscopic devices including endo-scissors, endoscopic hemoclips and electrocautery. Pathologically, the tumor was an esophageal cyst lined by ciliated columnar and squamous epithelium overlying smooth muscle layers. She made an uneventful recovery. Her back pain subsided following the operation. Thoracoscopic resection is a useful technique for patients with mediastinal cystic tumor.     

Transient inhibition of L929 cell mitosis and locomotion by argon ion laser irradiation

A 48-year-old woman was admitted to our hospital because of abnormal shadow on the chest X-ray. Chest contrast CT scan showed roundly mass in the posterior mediastinum which were combined with and without contrast elements, and chest MRI (T2 weighted) showed high signal intensity. These features suggested mediastinal cyst or extralobar sequestration. The operation was performed through left 6th intercostal thoracotomy. Two different lesions connected to the mediastinum were confirmed, a cystic tumor and small accessory lung. The former was diagnosed as bronchogenic cyst and the latter as extralobar pulmonary sequestration.     

A case report of giant esophageal leiomyoma associated with an epiphrenic esophageal diverticulum

A well-nourished 33-year-old male, who was entirely asymptomatic and in apparently good health, was referred to our hospital because of abnormal findings on a routine chest X-ray film. A chest X-ray taken upon admission revealed an oval mass suggesting a mediastinal tumor in the posterior mediastinum. An esophagogram demonstrated severe distortion of the esophageal lumen and an epiphrenic diverticulum on the right side. Endoscopy disclosed a submucosal bulge covered by normal mucosa. The mass, which was located on the right diaphragm between the heart and right ribs, appeared to be of homogenous density on CT scan and MRI films. Infiltration of contiguous structures and enlargement of mediastinal lymph nodes appeared to be absent. The preoperative diagnosis was an esophageal leiomyoma. A right posterior thoracotomy was performed in the prone position under general anesthesia. The tumor (12 x 8 x 4.5 cm, 170 g) associated with an epiphrenic esophageal diverticulum was removed by a partial esophageal resection. The pathologic specimen showed a leiomyoma with normal esophageal mucosa and a true diverticulum containing all the layers of the esophageal wall. We suggest that the diverticulum resulted from retraction of the esophageal wall related to the extraluminal growth of the leiomyoma.     

Rupture of the aortic arch due to bacterial aortitis--a case report of a patient undergoing successful surgical therapy

A 59-year-old man came to our hospital because of hoarseness and chest pain. On initial examination, a chest roentgenogram showed no abnormality. Three weeks later, while the patient was waiting to undergo a computed tomographic (CT) scan, shock suddenly developed. A chest roentgenogram revealed an extremely wide mediastinal shadow. A CT scan revealed rupture of the aortic arch near the base of the left subclavian artery, although there was no aneurysm. An emergency operation was performed. The ruptured aortic arch was replaced with an artificial graft during cardiopulmonary bypass with selective cerebral perfusion. A diagnosis of infectious aortitis was not made until a pathologist discovered colonies of gram-positive cocci in the resected specimen of the aortic arch. Postoperatively, antibiotics were administered for only four days. The patient is well about two years after the operation. Infectious aortitis had a very low prevalence and rarely involves the thoracic aorta. However, we should be aware of that it may cause aortic rupture even in the absence of aneurysmal dilatation.     

A case of relapsed thymic carcinoma that responded remarkably to chemotherapy with CPT-11

A chemotherapeutic protocol for advanced thymic carcinoma has not been established as yet. We described a case of advanced and relapsed thymic carcinoma that responded remarkably to subsequent chemotherapy with CPT-11. A 61-year-old man was admitted to our hospital because of facial edema and general fatigue. Chest X-ray and CT scan showed anterior mediastinal tumor which involved large vessels and pericardium. CT guided needle biopsy yielded a diagnosis of squamous cell type of thymic carcinoma. The patient was initially treated with ADOC (ADM, CDDP, VCR, CPA) chemotherapy and had successfully controlled for six months. However, the mediastinal tumor recurred and radiotherapy and nedaplatin plus ETP therapy were not effective. Then, CPT-11 chemotherapy (80 mg/m2, 2 weeks) was performed. The patient showed a partial response after two courses of CPT-11 chemotherapy. This case suggests that CPT-11 is a useful chemotherapeutic agent for advanced thymic carcinoma.     

Treatments for hepatocellular carcinoma in cirrhosis : practical aspects]

A 44-year-old woman was admitted to our hospital for evaluation of an abnormal lung shadow. Chest computed tomography (CT) revealed a tumor surrounded by air-space and an infiltrative shadow in the right S2. Right upper lobectomy was performed and pulmonary sclerosing hemangioma was diagnosed. Usually, pulmonary sclerosing hemangioma shows a solitary round nodule on a chest CT scan. We report a case of pulmonary sclerosing hemangioma with an unusual shadow on a chest CT scan, and review the literature.     

Subependymal tumor with metaplastic bone formation: a case report

A 26-year-old woman was admitted to our hospital because of headache. CT scan and MRI showed a right subependymal nodule and a left ventricular tumor, neither of which had any enhancement nor were they stained in angiography. Although no skin abnormality was detected, the patient was suspected of tuberous sclerosis. The diagnosis was made because of the subependymal nodule on CT scan and MRI. On June 29, 1995, total removal of a left ventricular tumor was performed by a transcortical approach. Histological sections of this tumor consisted of astrocytic and meningothelial components, containing metaplastic bone formation. Histological diagnosis was dysplastic subependymal tumor. Postoperative course was uneventful. Regrowth of the tumor has not been observed as of now. This case was suspected to involve factors of tuberous sclerosis from a subependymal nodule. However, the ventricular tumor was not diagnosed as a subependymal giant cell astrocytoma.     

A case of T-cell malignant lymphoma developing in the chest wall of chronic pyothorax after artificial pneumothorax

A 66-year-old man, with a past history of artificial pneumothorax for pulmonary tuberculosis at the age of 17, was admitted to our hospital because of progressive left precordial pain and left anterior chest wall tumor. Because of chronic pyothorax complicated by a tumor suggested by imaging diagnosis, surgery was performed for the purpose of fenestration. A diagnosis of diffuse large cell T-cell malignant lymphoma was made by the biopsy taken at surgery. Postoperatively the patient received 6 courses of combination chemotherapy with CHOP, the course turned favorable. The left precordial pain and tumor disappeared. The patient is doing well at 11 months postoperatively. Recently, cases of malignant lymphoma developing in the chest wall of chronic pyothorax have been increased and the majority of cases of the malignant lymphoma is B-cell type. T-cell type is rare. Follow-up of chronic pyothorax's patients necessarily are attentioned on the developing of the malignant lymphoma.     

Comparative susceptibility of Glossina longipennis and G. brevipalpis to pathogenic species of Trypanosoma

A 56-year-old woman was admitted to our hospital with the chief complaint of left back pain. We detected left pleural effusion on chest X-ray and performed chest drainage. No malignant cells were detected in the effusion. Chest CT demonstrated a tumor shadow over the left diaphragm and left pleural effusion 6 months later. She underwent en bloc resection of the tumor and left diaphragm. Histological evaluation revealed malignant fibrous histiocytoma (MFH). Recurrent tumors were found in the abdomen 8 months after the operation, and she underwent resection of the abdominal recurrent tumors. Histological evaluation of the recurrent tumors also showed MFH. The patient died 28 months after the first operation.     

Mediastinal teratomas: review of 15 pediatric cases

One hundred fifty-three children with a teratoma presented to one hospital between 1970 and March 1992. The clinical and pathological features of 15 patients with mediastinal teratomas are reviewed; six were newborn and nine aged from infancy to 13 years. Thirteen patients including the six newborns presented with respiratory distress and all 15 patients had a mass on chest radiograph. A definite diagnosis of teratoma was not made preoperatively in any of these patients. At operation, a median sternotomy was used to approach seven anterior tumors and a lateral thoracotomy performed in the other eight patients. Histologically two were mature, 10 had immature elements, and three were malignant teratomas. The patients with malignant tumors were all over 12 years of age and died within 6 months of treatment. All six neonates had immature teratomas. Raised serum alpha-fetoprotein levels provided useful markers in two patients with recurrent tumors. Three conclusions can be drawn: (1) mediastinal teratomas are rare in children and frequently are not diagnosed before operation; (2) in newborns these tumors may be immature and present with respiratory distress; and (3) a median sternotomy gives excellent exposure for anterior mediastinal tumors.     

Fulminant myasthenia gravis manifested after removal of anterior mediastinal tumor

Myasthenia gravis developed in a 35-year-old man after removal of an encapsulated anterior mediastinal tumor that was preoperatively diagnosed as a teratoma based on a computed tomographic image. Postoperative pathologic diagnosis of the excised tumor was thymoma. The patient was in crisis after the initiation of immunosuppressive treatment. The therapy was changed to immunoadsorbent perfusion therapy because of concurrent severe pneumonia and an extremely high serum concentration of anti-acetylcholine receptor antibodies. Respiratory support was necessary for 2 months after reoperation.     

Plasma cell interstitial pneumonia as a manifestation of multicentric Castleman's disease

A 12-year-old boy was admitted to our hospital because of abnormal shadows on a chest radiograph, slight fever, and superficial lymphadenopathy. Laboratory examination showed anemia (Hb 9.9 g/dl) and hyperimmunoglobulinemia (IgG 5469 mg/dl) without M protein. A chest CT scan showed bilateral diffuse shadows and bilateral hilar lymphadenopathy. Biopsy specimens of an inguinal lymph node and a lung showed many lymphoid follicles with germinal centers, and marked infiltration of mature plasma cells in the interfollicular area without destruction of follicular structures. The polyclonality of the plasma cells was confirmed by immunohistochemistry. The patient was not treated because these results excluded malignant disease and he was asymptomatic. At the age of 17 years, he was admitted to our hospital again because of dyspnea and a tendency to bleed. Interstitial pneumonia, hyperimmunoglobulinemia (IgG 13900 mg/dl), and anemia (Hb 6.6 g/dl) were found, along with thrombocytopenia (2.5 x 10(4)/mm3) and proteinuria. The serum interleukin-6 level was high: 177 pg/ml. Bronchoalveolar lavage fluid contained many plasma cells. Therapy with corticosteroids and immunosuppressant medication was effective. Our diagnosis was plasma cell interstitial pneumonia as a manifestation of multicentric Castleman's disease.     

A case of complete circumferential aortic rupture due to blunt chest trauma

A case of complete circumferential rupture of the thoracic aorta due to blunt chest trauma is presented. A 30-year-old man was admitted after a traffic accident. The admission chest X-ray film demonstrated mediastinal widening. About 6 hours after the traffic accident, chest CT scanning demonstrated mediastinal hematoma, left pleural effusion and partial aortic dissection. Diagnoses of aortic rupture and liver injury were made, and surgery for the thoracic aorta was performed immediately. The aorta was found to be completely disrupted for the length of 2 cm, and a vascular prosthesis was interposed between the two ends of the aorta under partial cardiopulmonary bypass. We conclude that the enhanced chest CT scanning is helpful for diagnosis, and that if other organ injuries are not severe, the emergency operation should be performed.     

Tuberous sclerosis associated with renal angiomyolipoma, pulmonary lymphangioleiomyomatosis and subungual fibroma: report of a case

We report a case of tuberous sclerosis associated with bilateral renal angiomyolipomas (AMLs), pulmonary lymphangioleiomyomatosis (LAM) and subungual fibroma of hands and feet. A 42-year-old woman who was diagnosed as tuberous sclerosis at the age of 18 complained of left flank pain and abdominal fullness. Bilateral renal AMLs were pointed out when complete examinations were performed for hypertension at the age of 32. She suffered from severe left flank pain and abdominal distension due to the left renal tumor. Left nephrectomy and excision of the renal hilar tumor were performed. The left renal tumor weighed 1120 g, the perirenal space was filled with the tumor. histopathological diagnosis of the left renal tumor and renal hilar tumor was AML. In our case, bilateral pneumothorax appeared, and chest CT scan revealed bilateral multiple pulmonary cysts. Histopathological diagnosis of pulmonary cysts was LAM. Other complications of our case are intracranial calcification and adenoma sebaceum.     

Granulocyte colony stimulating factor (G-CSF) producing renal cell carcinoma

A 88-year-old male patient with G-CSF producing renal cell carcinoma is reported. The patient was admitted to our hospital complaining of macrohematureia. The laboratory examination showed marked leukocytosis of 18,200/microliter (neutrophil 92%) in the peripheral blood and high levels of G-CSF (120 pg/ml) in the serum. An abdominal CT scan revealed a right renal tumor. The neutrophil count rose to 38,700/microliter with increasing of tumor size. Histopathological diagnosis was renal cell carcinoma (Grade 3) and immunohistochemical staining using Histo anti-G-CSF antibody demonstrated cancer cells produced G-CSF. This is the second case of G-CSF producing renal cell carcinoma diagnosed by immunohistochemical staining in the literature.     

Sarcoidosis in a patient with autoimmune hemolytic anemia

A 65-year-old woman was admitted to our hospital because of severe anemia. A skin biopsy was done in January 1994 and sarcoidosis was diagnosed. Diffuse reticular shadows were seen in both lung fields on a chest X-ray film and mediastinal lymph node swelling was seen on a chest CT scan. She was followed as an outpatient and was not treated. She suddenly experienced vertigo and general fatigue in March 1995. Laboratory findings on admission were as follows: Hb 6.2 g/dl, MCV 115.9 fl, Ret 198%, LDH 732 IU/L, I-Bil 1.9 mg/dl, and Coombs' test was positive. Autoimmune hemolytic anemia was diagnosed, and she was treated with prednisolone (1 mg/kg). As of the time of this writing, she has no relapse of hemolytic anemia though prednisolone was discontinued 6 months ago.     

An early recrudescent case of Stanford type A closing aortic dissection

A 81-year-old female was hospitalized with chest discomfort. Findings of CT scan revealed Stanford type A acute aortic dissection, but the dissecting lumen had already closed with thrombus. Aortogram showed no intimal tear, intimal flap or ulcer like projection. Under the diagnosis of "closing aortic dissection", conservative treatment was selected. The dissecting lumen was disappearing gradually, but she had a sudden chest pain on hospital day 4 and CT scan demonstrated an enlarged and enhanced dissecting lumen. She underwent an emergency operation and a hemiarch replacement was performed successfully. Her postoperative course was uneventful and she was discharged from the hospital in good health.     

Squamous cell carcinoma and infection in a solitary hepatic cyst

A case of mediastinal cavernous hemangioma was reported. An abnormal shadow on the chest X-ray film was pointed out in a 55-year-old male. CT scan and MRI revealed a right posterior mediastinal tumor but did not aid in the final diagnosis. We underwent extirpation of the tumor through thoracoscope and confirmed to be a cavernous hemangioma histologically. No major vascular connections between the tumor and major vessels were found. It was useful of thoracoscopic surgery in this case.     

Neovascularization and HGF: neovascularization in proliferative diabetic retinopathy and intraocular HGF

We experienced a case of multiple bilateral giant bullae of the lungs and treated by thoracoscopic bilateral resection. A 46-year-old male was admitted to our hospital on the diagnosis of bilateral giant bullae of the lungs. Chest CT scan and lung perfusion scintigraphy showed giant bullae at the apex of both lungs and at the left lower lobe. The border of the bullae was relatively clear, and the other lung was almost normal although it was compressed by the bullae. We evaluated this case and found that it was a good indication for a thoracoscopic bilateral resection. The patient was positioned on his back, and a successful thoracoscopic bilateral resection was performed. The patient was discharged from the hospital on the 10th day postoperatively. Chest CT scan, lung perfusion scintigraphy and respiratory function test performed 2 months postoperatively, showed remarkable improvement. We would recommend this surgical technique in patients with similar diagnosis.