Trans-arterial infusion chemotherapy for recurrence of pleural dissemination after thymectomy.

We present a report of trans-arterial infusion chemotherapy through the intercostal arteries and subphrenic artery for pleural dissemination of recurrent thymoma after thymectomy. The disseminated tumor did not enlarge for more than a year after this treatment, and there were no side effects. Trans-arterial infusion chemotherapy appears to be a preferable procedure for pleural dissemination of thymoma.

[A case of infected emphysematous bulla successfully treated with percutaneous thoracic drainage].

We present a case of infected emphysematous bulla successfully treated by percutaneous drainage. A 39-year-old man was admitted to our hospital because of fever and right lateral chest pain. A chest radiograph and CT revealed a cystic lesion with an air fluid level in the upper lobe of the right lung. The infected emphysematous bulla was not improved by the administration of antibiotics. On day 6 of hospitalization, a drainage tube (Aspiration Kit: 6 Fr) was inserted percutaneously into the bulla under fluoroscopic guidance. The infection subsided on the next day, and the patient was discharged following a week of drainage without complications.

A case of thymoma protruding into the superior vena cava through the thymic vein.

We describe an unusual case of an invasive thymoma protruding into the superior vena cava and left brachiocephalic vein through the thymic veins in a 64-year-old patient. The tumor was resected with a bypass of the right brachiocephalic vein and right atrium. Although this type of growth form is rare for an invasive thymoma, this case suggests that in surgical procedures for thymomas, meticulous examination of the thymic veins is necessary to avoid leaving residual tumor.

[Two cases of intramedullary spinal cord metastasis of lung cancer detected with MRI].

We report two cases of intramedullary spinal cord metastasis of lung cancer detected by MRI. Case 1: A 77-year-old man underwent chemotherapy and left lower lung lobectomy for squamous cell carcinoma of the lung (T2N0M0). About one year later, he complained of paresthesia of the lower extremities and claudication on walking, and then of weakness of the lower limbs and bladder dysfunction. Magnetic resonance imaging (MRI) revealed an enhanced mass in the dural sac at the level of the spines of L1-2. Volume reduction surgery was promptly performed. The pathological diagnosis was squamous cell carcinoma. Case 2: A small cell carcinoma of lung with metastasis to bone, kidney and cerebellum (T4 N3 M1) in a 73-year-old man was diagnosed. He showed a partial response to chemotherapies and to whole brain radiation (45 Gy). Three months later, he presented sudden onset paraplegia, paraesthesia and bladder dysfunction. MRI demonstrated an enhancing intramedullary lesion that delineated the conus of the cauda equina, and T 2-weighted MRI images showed multiple nodules in sacs.

[A case of paraneoplastic syndrome improved following chemoradiotherapy for lung cancer].

Paraneoplastic neurosyndrome (PNS) is a group of neurological disorders caused by or associated with neoplasms that are not direct effects of the primary tumor or of a metastasis to the involved organs. Chemotherapy, radiotherapy, immunosuppressive therapy, and plasmapheresis have been performed to treat PNS, but improvement of the neurological disorder is rather rare. A 64-year-old man was referred to our hospital with dysesthesia of the extremities and ataxic gait. Small cell lung cancer was diagnosed in another hospital and chemotherapy (CDDP 80 mg/m2 + VP-16 100 mg/m2) was performed. A partial response was obtained with this treatment, but the neurological dysfunction was exacerbated. Three months later, the patient was admitted to our hospital. On treatment with CDDP 80 mg/m2 (day 1) and CPT-11 80 mg/m2 (days 1, 8 and 15) and subsequent radiation therapy (60 Gy), his neurological disorder improved. We consider that neurological symptoms are important signs of malignancy in PNS and that a full course of treatment could improve the neurological disorders.

Bilateral pleural effusion and pulmonary edema caused by a fistulous aneurysm of the ductus arteriosus.

We report an unusual case of pulmonary edema and rapid collection of bilateral pleural effusion caused by a fistulous large aneurysm of the ductus arteriosus (DAA). The diagnosis was performed by contrast CT and aortography. The cause of pulmonary edema and effusion was thought to be both elevated capillary pressure due to overload of the pulmonary circulation and decreased water clearance due to compression of the lymphatic system by the large DAA itself. Therefore, fistulous DAA should be considered when a continuous heart murmur and swelling in the aortic window are recognized. Once DAA is diagnosed, surgery should be performed without delay.

[Mediastinal tuberculous lymphadenitis in a chronic renal failure patient with elevated serum pro-GRP level].

A 56-year-old man treated by peritoneal dialysis was admitted to our hospital because of abnormal shadows on chest radiographs. Chest CT revealed enlarged paraaortic lymph nodes (30 mm x 40 mm) and a tuberculoma in the left upper lobe. The serum level of pro-GRP was significantly above the cutoff value, but tuberculous mediastinal lymphadenopathy was identified from mediastinal lymph node biopsy specimens. We concluded that the elevation of the serum pro-GRP concentration was due to decreased renal clearance resulting from the chronic renal failure.

[A case of true pulmonary carcinosarcoma].

A 72-year-old male was admitted to our hospital because of dyspnea. A chest radiograph showed a mass shadow measuring 40 x 40 mm in the left lower lobe, and fiberoptic bronchoscopy revealed obstruction of the left B8 by the tumor. Adenocarcinoma was suspected after a transbronchial biopsy, and left lower lobectomy was performed. Histologically, the resected specimen was composed of carcinomatous and sarcomatous elements, and further immunohistological study revealed that the former component was poorly differentiated squamous cell carcinoma and the latter was fibrosarcoma. We therefore concluded that the tumor was a true carcinosarcoma of the lung.