[Hourglass Transmural Lipoma;Report of a Case].

This case report describes a 73-year-old male with an hourglass-type transmural lipoma who was referred because of an abnormal chest shadow. Computed tomography showed a well-defined fatty mass within the intra-and extra-thorax at the right 3rd intercostal portion. Magnetic resonance imaging showed a high-intensity mass that had the same signal level as fat tissue. Therefore, the tumor was diagnosed as an hourglass transmural lipoma. Tumor resection was performed with video-assisted thoracic surgery, and 3rd intercostal muscle tissue approximately 1cm from the tumor border was also resected. The tumor was 6.5×4.5×3.0 cm in size, and histologically diagnosed as an intramuscular lipoma-infiltrating type, without malignancy. Since infiltrating types of intramuscular lipoma often cause recurrence without malignant appearance, tumor specimens require careful examination. Thoracoscopic surgery was useful to determine the excision line from the intra-thorax, for complete resection of the hourglass tumor.

[Langerhans cell histiocytosis of the rib in adult male].

A 57-year-old man was admitted to our hospital with an abnormal shadow on chest X-ray film. Computed tomography (CT) scanning demonstrated a low-density, destructive mass on the right 8th rib. The maximum standardized uptake value of the tumor measured by positron emission tomography (PET) was 2.9, indicating malignancy. Wide resection of the tumor, including the right 8th rib and the 7th to 8th intercostal muscle, was performed. Chest wall reconstruction was achieved with Composix Mesh. The histologic findings revealed proliferation of histiocytes and eosinophil infiltration. No malignant cells were detected in the tumor. Histiocytes stained for S-100 protein and CD1a, compatible with a diagnosis of Langerhans cell histiocytosis (LCH). LCH in the ribs is very rare and difficult to diagnose using CT or PET. Tumor biopsy or resection is needed to diagnose LCH.

[A case of postoperative recurrent lung cancer with chronic renal failure and respiratory failure successfully treated with gefitinib].

We administered gefitinib to a patient after considering his request to be treated with the drug. Fortunately, he responded favorably to the treatment and did not show signs of serious adverse effects or deterioration of renal functions. The patient was a 69-year-old male who visited an outpatient clinic because of chronic renal failure and was diagnosed with primary lung cancer. He then underwent an operation for lung cancer, but because it had progressed to stage IV the lesion was not completely resected. The patient was unable to receive effective chemotherapy due to the prior chronic renal failure. During best support care, the patient suffered from respiratory failure due to the tumor growth, and his quality of life (QOL) deteriorated. The patient was administered 250 mg of gefitinib orally, which was effective in reducing the tumor, improving his QOL, and prolonging his survival time. With the lack of literature on administering gefitinib to patients with chronic renal failure and evidence supporting the effectiveness of this treatment, the physician in charge should obtain the patient's informed consent before initiating treatment using this anticancer drug.