Three Cases of Resection of Late Recurrence of Breast Cancer that Required Differential Diagnosis of Primary Lung Cancer.

We report 3 cases of surgical resection for lung metastasis more than 15 years after initial surgery for breast cancer. Case 1: A 77-year-old woman was referred to our hospital because of a lung nodule in the left lower lobe detected in a computed tomography (CT) scan. She had undergone breast preservation therapy for breast cancer 15 years before the first visit. Left lower lobectomy was performed via video-assisted thoracoscopic surgery (VATS). The pathological diagnosis was lung metastasis of breast cancer, based on positive immunohistochemical staining of estrogen receptor (ER) and gross cystic disease fluid protein 15 (GCDFP-15). Case 2: An 88-year-old woman had undergone a mastectomy for breast cancer 23 years previously. A CT scan revealed a nodule in the upper lobe of the left lung. A wedge resection of the left upper lobe was performed. Because immunostainings for progesterone receptor (PgR) and GCDFP-15 were positive, the pathological diagnosis was metastasis of breast cancer. Case 3: A 78-year-old woman had undergone right mastectomy for the breast cancer 29 years previously. The patient was referred to our hospital because of a nodule in the right lung in a CT scan. Thoracoscopic right upper lobectomy was performed. The pathological diagnosis was lung metastasis of the breast cancer, with immunohistochemical positivity to ER, PgR, and focally to GCDFP-15. A differential diagnosis between primary lung cancer and metastasis of breast cancer on the basis of the findings of a CT scan is often difficult. It is important to obtain the previous clinical information about the breast cancer before VATS, even in patients with a long disease-free interval of more than 15 years.

Aspiration of a drug in a blister pack.

We report a rare case of aspiration of a drug in a press-through package (PTP) treated by not just pulling it but using a unique technique. A 73-year-old woman was referred to our department because of a persistent cough resulting from aspiration of a PTP. Flexible bronchoscopy identified the PTP in the trachea immediately above the carina. Just pulling the centre of the PTP edge with biopsy forceps could not move it, and we then rotated it by pulling the corner of the PTP edge to directly below the vocal cord. Passing over the vocal cord was difficult, which made us remove the bronchoscope and urge the patient to cough. These rotation techniques and voluntary coughing successfully removed the foreign body. This unique procedure may aid in the removal of a similar foreign body using a flexible bronchoscope forceps with insufficient grasping force.

[Two Resected Cases of Primary Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma, Differently Diagnosed in Chest Tomography Scan].

Case 1: A 81-year-old man was admitted to our hospital because of a mass shadow on chest x-ray examination. Chest computed tomography (CT) showed a 1.5 cm nodule in the middle lobe of the right lung. We suspected a primary lung cancer and performed video-assisted right middle lobectomy. Histopathological examination showed a white, elastic, hard and solid 30 × 10 × 10 mm nodule with infiltration of small-to-medium-sized lymphocytes that were positive for CD20 and CD79a, and negative for CD10 and Cyclin D1 in immunohistochemical staining. We diagnosed mucosa-associated lymphoid tissue (MALT) lymphoma. Case 2: A 67-year-old woman was admitted to our hospital because of a mass shadow in the right upper lobe on chest x-ray and chest CT. As the lesion had not grow in 1 year, the patient strongly wanted it resected, therefore we performed wedge resetion of the right upper lobe via video-assisted thoracic surgery. Histopathological examination showed a white, elastic, hard and solid 25 × 25 × 16 mm nodule with infiltration of small-to-medium-sized lymphocytes that had positive staining of CD20 and CD79a, and negative staining of CD10 and Cyclin D1. We diagnosed MALT lymphoma. Primary lung MALT lymphoma shows a variety of shadows on chest CT, similar to lung cancer and other inflammatory diseases. Local therapies such as surgery and radiation therapy are effective against early stage MALT lymphoma, but there is no consensus of a standard surgery.

Primary epithelial-myoepithelial carcinoma of the lung with cavitary lesion: A case report.

Epithelial-myoepithelial carcinoma (EMC) typically arises in the salivary glands, whereas EMC of the lung is an extremely rare histological form that originates from the bronchial glands. Although cavitation in primary lung cancer is not uncommon, to the best of our knowledge, a case of EMC with a cavitary lesion has not been reported to date. We herein describe a case of cavity-forming pulmonary EMC. A 72-year-old man was referred to our department due to a thickened cystic wall discovered in the upper lobe of the left lung and underwent thoracoscopic left upper lobectomy. Microscopically, the tumor was characterized by biphasic architecture, with glands surrounded by myoepithelial cells. The pathological diagnosis was EMC. The patient has remained in good health for 2 years postoperatively, without any evidence of recurrence. As regards the mechanism of cavity formation, it was hypothesized that the bronchial gland in the primary cystic lesion had been present 3 years prior to the development of the EMC, and grew to become a cavitary lesion. Therefore, although the mechanism of cavity formation remains to be elucidated, EMC of the lung may include a cavitary lesion.

Single-incision subxiphoid approach for bilateral metastasectomy.

We report a case of single-incision bilateral partial lung resection using the subxiphoid approach. This approach requires a 3-cm incision in the abdomen, making it aesthetically favorable. In addition, it does not cause postoperative intercostal neuropathy, and postoperative pain is minimal because the intercostal space is bypassed. Moreover, this technique enables exposure to both lungs through a single incision and has potential for widespread use if maneuverability can be increased by improving the instruments used.

Dual-port thymectomy using subxiphoid approach.

We have previously reported single-port thymectomy (SPT) through an infrasternal approach, a procedure in which the thymus is removed through a single port. The dual-port thymectomy procedure developed by adding another port to the single-port procedure has eliminated the risk of interference between forceps operated by both hands of the surgeon and has thereby significantly simplified operative procedures. This procedure provides the same operative field as that obtained by median sternotomy and has excellent maneuverability of devices. Therefore, the dual-port procedure can be used by surgeons who have not been sufficiently trained for SPT, as an alternative procedure in the event of experiencing technical difficulty during SPT, or as a new approach for thymectomy.