[A Surgical Case of Intrapulmonary Bronchogenic Cyst Treated by Left Lower Lobectomy for Hemopneumothorax and Repeated Hemoptysis].

A 79-year-old female visited a hospital because of high fever and computed tomography(CT)showed a cystic lesion with fluid accumulation in her left lung. She had hemoptysis and left chest pain 3 days after antibiotic therapy was started. Chest CT demonstrated the cystic lesion rupturing and causing hemopneumothorax. Then she was referred to our department and thoracic drainage was performed. However, a week after the drainage, she had hemoptysis and chest pain again, and the left lower lobectomy was performed. Histopathological findings showed the cystic lesion was intrapulmonary bronchogenic cyst. We describe a rare case of the hemopneumothorax due to the hemorrhage in the bronchogenic cyst.

Anatomical consideration of the cardiac plexus to prevent grave bradycardiac arrhythmias associated with lung cancer surgery: a case report.

BACKGROUND: Arrhythmias are known as one of the complications of lung cancer surgery, and most of them are not lethal. Life-threatening arrhythmias have been reported in the literature but in reality very rare. CASE PRESENTATION: A 67-year-old Japanese man with a history of hypertension was diagnosed with squamous cell carcinoma in left lower lobe underwent a left lower lobectomy and bilateral mediastinal lymph node dissection through a median sternotomy. During lymph node dissection along the right vagus nerve, the patient's heart rate and blood pressure dropped suddenly and an electrocardiogram monitor showed ST elevation. These abnormalities returned to normal soon after cardiac massage was performed and a coronary vasodilator was given. A temporary pacing wire was inserted at the end of the surgery. The postoperative course was uneventful and the patient was discharged on postoperative day 11 without a need for permanent pacemaker. CONCLUSIONS: We present a patient who was complicated with lethal arrhythmias during lung cancer surgery for the purpose of elucidating, from anatomical viewpoint, the relationship between arrhythmias and the involvement of cardiac plexus during lymph node dissection. The result showed that arrhythmia was inadvertently elicited by cardiac plexus stimulation during lymph nodes dissection around the vagus nerve. It is important to be familiar not only with the course of phrenic, vagus, and recurrent laryngeal nerve but also the anatomy of cardiac plexus to prevent arrhythmic complications in lung cancer surgery.

Nivolumab-induced myocardial necrosis in a patient with lung cancer: A case report.

A 74-year-old man with lung adenocarcinoma recurrence was admitted to our hospital because of dyspnea 7 days after receiving initial immunotherapy with nivolumab. Electrocardiography revealed ST-segment elevation in V1-6 and echocardiography showed a markedly reduced left ventricular ejection fraction of 9% and akinesis of the anteroseptal wall and apex. He died from acute heart failure 3 days after admission. Microscopically, multiple small foci of myocardial necrosis with few inflammatory cells were scattered in both ventricles. Obstruction of the coronary artery was not identified. We believed that the cause of death was acute heart failure possibly due to nivolumab-induced myocardial necrosis.

Transcatheter aortic valve implantation for patients with lung cancer and aortic valve stenosis.

Many patients who require lung resection have cardiovascular and cerebrovascular comorbidities. It has been recommended that surgical aortic valve replacement (SAVR) should precede lung resection in patients with severe aortic valve stenosis (AS). However, by first undergoing transcatheter aortic valve implantation (TAVI), the patient may undergo lung resection more safely. We present two patients with both severe AS and lung cancer who underwent TAVI and lung resection without any complications.

Sclerosing rhabdomyosarcoma of a chest wall in an adult: a case report and review of the literature.

Sclerosing rhabdomyosarcoma (SRMS) is a newly recognized and rare variant of rhabdomyosarcoma. This soft tissue tumor has not yet been reported as a thoracic lesion. We report a case of a 26-year-old woman who presented with a large chest wall tumor. The tumor originated from the right anterior chest wall and protruded into the intra- and extrapleural cavity. A transcutaneous needle biopsy revealed spindle cells in an abundant hyalinized and fibrous stroma. Although the tumor was considered as a malignant soft-tissue neoplasm, a definitive diagnosis could not be established. A wide excision of the chest wall including the second, third and fourth rib and a part of sternum was performed. Histologically, cytoplasmic cross-striations were found in a portion of the tumor cells. The tumor cells were positive for muscle markers, and the tumor was diagnosed as rhabdomyosarcoma consistent with a sclerosing type of rhabdomyosarcoma. Eighteen months after the complete resection, the patient has pleural disseminations but is alive and undergoing chemotherapy. This case highlights the histologic features of a rare form of rhabdomyosarcoma, and emphasizes the importance of awareness of its existence and the utility of skeletal muscle markers in distinguishing sclerosing rhabdomyosarcoma from its mimics.

Pulmonary resection of lung cancer in a patient with partial anomalous pulmonary venous connection.

We report a case of a 64-year-old man in whom a partial anomalous pulmonary venous connection (PAPVC) was found before right lower lobectomy for lung cancer. In addition to lung cancer, there was a right superior pulmonary vein that drained into the superior vena cava (SVC). There was a concern of right ventricular heart failure resulting from increased left-to-right shunt flow after lobectomy. Therefore cardiac catheterization was performed to calculate the pulmonary-to-systemic flow rate in the presence of blocked blood flow to the lower lobe pulmonary artery. As a result, we successfully performed lobectomy without correcting the PAPVC.

Angiomyolipoma in the lung detected 15 years after a nephrectomy for renal angiomyolipoma.

Angiomyolipoma is generally found in the kidney, but is especially rare in the lung. Nine cases of angiomyolipoma in the lung have been reported previously, and in 3 of these patients it was involved with nephrectomy for renal angiomyolipoma. The origination of the tumor was not completely recognized, but lymphangioleiomyomatosis and angiomyolipoma are known to have a common feature. The pathogenesis of angiomyolipoma in the lung has recently been researched in relation with lymphangioleiomyomatosis. We review these case reports of angiomyolipoma in the lung and discuss the clinical features and the generation of these tumors.

Comparison of different clones (WT49 versus 6F-H2) of WT-1 antibodies for immunohistochemical diagnosis of malignant pleural mesothelioma.

Malignant pleural mesothelioma (MPM) is known to mimic the morphology of a number of diverse neoplastic conditions. WT-1 protein is conventionally used as a positive mesothelioma marker. Recently, a new monoclonal antibody clone WT49 has recently become commercially available. To compare specificity and sensitivity of the conventionally used clone 6F-H2 for the diagnosis of MPM to those of the new clone WT49. Forty cases of MPM, and 55 cases of lung carcinoma, 10 cases of synovial sarcoma of the intrathoracic region were analyzed. Of the 40 cases of MPM tested, clone WT49 and 6F-H2 stained 30 (75.0%) and 26 (65.0%) cases, respectively. Nuclear staining of clone WT49 was observed in 4 (7.2%) cases of lung carcinomas and in 1 (10.0%) case of synovial sarcoma. However, there was no nuclear staining of clone 6F-H2 in lesions other than MPM. There was no cytoplasmic staining of clone WT49 in any tumor. However, cytoplasmic staining of clone 6F-H2 was observed in 7 (17.5%) cases of MPM, 17 (30.1%) cases of lung carcinomas, and 5 (50.0%) cases of synovial sarcoma. The main advantage of WT49 is its higher reactivity with the sarcomatoid area of biphasic mesothelioma, but the results also indicate 1 drawback, that this clone was seen to react with a small percentage of lung carcinomas when it is used to distinguish epithelioid mesotheliomas from lung carcinomas. Furthermore, the positive reaction of clone WT49 was restricted to nucleus without cytoplasmic staining, which is seen in conventionally used WT-1 antibodies.

Analysis of expression patterns of breast cancer-specific markers (mammaglobin and gross cystic disease fluid protein 15) in lung and pleural tumors.

CONTEXT: The lung is the most common site of metastasis during the natural history of malignant tumors. Breast carcinoma has a propensity for distant metastasis, and the lung and pleura are among the most common metastatic sites. Although it is often difficult to make a clear-cut differential diagnosis between the two, distinguishing primary lung carcinoma from breast carcinoma metastatic to the lung is important because the treatment modalities are different. OBJECTIVE: To elucidate the utility of mammaglobin and gross cystic disease fluid protein 15 (GCDFP-15), which are known to be breast-specific antigens, in distinguishing various primary lung and pleural tumors from breast carcinoma metastasizing to the lung. DESIGN: A total of 20 cases of breast carcinoma metastatic to the lung and 263 tumors of nonbreast origin located in the lung and pleura were analyzed. RESULTS: Of the 20 cases of breast carcinoma metastatic to the lung, 10 (50.0%) were immunoreactive for mammaglobin and 9 (45.0%) for GCDFP-15, the frequency of positivity being slightly higher for the former than for the latter. The area immunopositive for mammaglobin showed more diffuse staining than the area immunopositive for GCDFP-15. Furthermore, the specificity of mammaglobin for breast carcinoma metastatic to the lung was superior (98.9%) to that of GCDFP-15 (91.8%). CONCLUSION: The sensitivity of mammaglobin is equal or superior to that of GCDFP-15 for investigation of breast carcinoma. Immunopositivity for mammaglobin is more diffuse than that for GCDFP-15. In terms of practical diagnosis, mammaglobin immunohistochemistry can serve as a differential marker of breast carcinoma and should be added to the immunohistochemical panel.

Minute depressed-type submucosal invasive cancer-5 mm in diameter with intermediate lymph-node metastasis: report of a case.

We report a rare case of colon cancer in which a depressed-type tumor only 5 mm in diameter invaded the submucosal layer and produced intermediate lymph node metastasis. A 47-year-old male received a total colonoscopy for a depressed-type lesion with marginal elevation in the sigmoid colon. The lesion measured 5 mm in diameter. On chromoendoscopic examination, the depression was clearly demarcated and an irregular pit pattern was identified in the demarcated area by magnification suggesting invasion of the submucosal layer requiring surgery. Laparoscopic-assisted sigmoidectomy was performed and the resected specimen demonstrated well-differentiated adenocarcinoma. The depth of invasion was only 900 microm. There was no lymphovascular invasion although not only paracolic, but also intermediate lymph node metastasis was detected. There have been some reports about small depressed-type colorectal cancer invading the submucosal layer; however, intermediate LN metastasis is very rare in submucosal colorectal cancer. In this case, there were two noteworthy points: 1) despite the small size, submucosal invasion could be estimated preoperatively, therefore, a successful lymph node dissection was performed by laparoscopic surgery; and 2) although this depressed-type cancer invaded the submucosal layer only 900 microm and there was no lymphovascular invasion, intermediate lymph node metastasis was detected.