[Congenital Pericardial Defect Incidentally Discovered During Lung Cancer Surgery:Report of Two Cases].

Congenital pericardial defect is a rare congenital condition. It is often asymptomatic and discovered incidentally, frequently during autopsies, medical investigations, or surgery. Nevertheless, there are few reported cases of its discovery during lung cancer surgery. Lung cancer surgery can lead to changes in lung volume, potentially resulting in postoperative complications. Hence, it is crucial to consider potential complications and exercise caution when determining the course of action, taking into account the extent of the pericardial defect.

[Hepatic Hernia through a Diaphragmatic Defect Mimicking Pleural Tumor:Report of a Case].

Hepatic heria in adult without history of trauma or surgery is rare, and is sometimes operated under the diagnosis of lung or diaphragmatic tumor. Here, we report a case of hepatic hernia which had been preoperatively suspected of pleural tumor and surgically treated. At surgery, multiple lesions mimicking ectopic endometriosis were found on the diaphragma and hepatic profrusion was found from one of lesions.

Preoperative predictors of lymph node metastasis in clinical T1 adenocarcinoma.

BACKGROUND: The subcategory "solid component of tumor" is a new criterion of tumor categories in the updated eighth edition of the TNM classification. Nevertheless, the predictors of lymph node metastasis among patients with clinical T1 adenocarcinoma, based on the TNM classification 8th edition, remain unclear. This study aimed to identify the preoperative predictors of lymph node metastasis in clinical T1 adenocarcinoma by comparing clinicopathological characteristics between the groups with and without lymph node metastasis. METHODS: We performed a retrospective observational single-center study at the Sendai Kousei Hospital. From January 2012 to September 2019, we included 515 patients who underwent curative lobectomy or segmentectomy and mediastinal lymph node dissection among those with clinical T1 adenocarcinoma according to the UICC-TNM staging 8th edition. They were divided into two groups: those with lymph node metastasis (positive group) and those without (negative group). The clinicopathological factors were retrospectively analyzed and compared between the groups. RESULTS: In univariate analysis, carcinoembryonic antigen (>5.0 ng/mL) (P=0.0007), maximum standardized uptake (>3.5) (P<0.0001), clinical T factor (T1c) (P<0.0001), and consolidation tumor ratio (>0.85) (P<0.0001) were significant predictors of lymph node metastasis. Multivariate analysis revealed that maximum standardized uptake SUVmax (>3.5) (odds ratio =10.4, P<0.0001) was independently associated with lymph node metastasis. In univariate analysis, carcinoembryonic antigen (>5.0) (P=0.048) was the only predictor of lymph node metastasis among patients of cT1b, while no parameters were identified as significant predictors among patients of cT1c. CONCLUSIONS: SUVmax and CEA are useful preoperative predictors of lymph node metastases in patients with clinical T1 adenocarcinoma, stratified to T1b and T1c, based on the 8th TNM classification.

[Preoperative spontaneous regression of type B3 thymoma;report of a case].

A 65-year-old man experiencing chest oppression was admitted to our hospital. Contrast-enhanced chest computed tomography (CT) showed a 71×52-mm cystic mass with an enhanced wall in the thymus. The CT-guided needle biopsy of the tumor only revealed the presence of necrotic tissue. However, the tumor spontaneously decreased in size significantly to 33×21 mm in 2 months. The patient underwent right hemi-lobectomy of the thymus, which showed necrotic tissue in the center of the mass;the fibrotic cystic wall included several masses of type B3 thymoma cells( so called" well-differentiated thymic carcinoma", Masaoka stage II). Because of avoiding local recurrence, extended thymectomy including lymph node resection was additionally performed. The patient received radiation therapy postoperatively and has shown no sign of recurrence in 3 years of follow-up care.

Resection of a giant, invasive malignant solitary fibrous tumor of pleura.

Solitary fibrous tumor of pleura (SFTP) is a rare mesenchymal neoplasm that most commonly involves the pleura, is probably derived from fibroblasts, and has no relationship to malignant mesothelioma. Here, we report a case of complete resection of a giant malignant SFTP. A 61-year-old woman developed fever and left flank pain. Computed tomography revealed the tumor to be 13 cm in size and located in the left thoracic cavity, directly invading the left lower lobe of the lung. The patient underwent radical resection and left lower lobectomy. Immunohistochemical examination revealed a dense proliferation of spindle-shaped cells with ovoid nuclei and collagen fibers hyperplasia. The cells were positive for CD34 and vimentin, and were negative for cytokeratin AE1/AE3, calretinin, S-100 and smooth muscle α-actin. SFTPs have malignant potential, as 20-30 % of resected SFTPs reportedly contain malignant components. Careful long-term clinical follow-up is therefore required for all cases of SFTP.

Postoperative bronchial stump fistula after lobectomy: response to occlusion with polyglycolic acid mesh and fibrin glue via bronchoscopy.

Bronchial stump fistula after resection of lung cancer is an extremely difficult to treat postoperative complication. Endoscopic fistula closure is a favorable alternative, potentially avoiding major surgical intervention. an 80-year-old man underwent curative resection of squamous cell carcinoma by left upper lobectomy of the lung. The patient suddenly developed massive subcutaneous emphysema on postoperative day 10. Bronchoscopy revealed a fistula about 3 mm in diameter at the lateral edge of the bronchial stump. Concentrated fibrinogen 0.5 ml (fluid A) was sprinkled on the bronchial fistula initially, and then pieces of polyglycolic acid mesh presoaked in fluid A or fluid B (thrombin) of the fibrin glue were pushed with biopsy forceps into the fistula in an alternating fashion (A→B→A→B) under endotracheal local anesthesia. Air leakage was stopped, and the patient did not develop empyema. Particularly for patients in poor general condition, our noninvasive technique seems to serve as a therapy of first choice.

Late-onset chylothorax after pulmonary resection for lung cancer.

Chylothorax is a relatively rare complication of thoracic surgery. Most instances of chylothorax after pulmonary resection are diagnosed within 3 days after surgery. Hence, late-onset chylothorax is rare. A 68-year-old woman underwent right lower lobectomy and mediastinal dissection for lung cancer. After discharge, the patient developed a dry cough, and chest radiography more than 3 months after surgery revealed a right-sided pleural effusion occupying more than half of the right hemithorax, which we diagnosed as late-onset chylothorax. Treatment comprised chest drainage, subcutaneous octreotide, and pleurodesis by injecting a preparation of OK-432. Follow-up chest radiography confirmed no reaccumulation of fluid. Three months later no recurrence of pleural effusion was detected. We report a rare case of postoperative late-onset chylothorax that proved difficult to treat.