[The Successful Reduction of Resected Lung Volume for Intralobar Pulmonary Sequestration with Infrared Thoracoscope].

A 59-year-old male patient was referred to our hospital for further examinations and treatment due to an abnormal shadow detected in his left lower lung lobe on computed tomography. The patient was diagnosed with intralobar pulmonary sequestration and scheduled for an operation. During the surgery, after resection of the aberrant artery, indocyanine green was intravenously injected, and the border between normal lung and sequestrated lung was clearly identified by an infrared thoracoscope. Subsequently, wedge resection was performed, and the patient was discharged on postoperative day 5. Spirometry performed 6 months after the surgery indicated that the patient's lung function was well-preserved compared to the preoperative status.

[Metastases in the Lung and Mediastinal Lymph Nodes from Breast Cancer 28 Years after the First Operation:Report of a Case].

A 76-year-old woman was pointed out a small nodule in the right lower lung lobe on a chest computed tomography( CT) for follow-up examinations of malignant thyroid lymphoma. Although she had undergone a radical mastectomy for right breast cancer 28 years previously, the nodule was suspected to be either metastatic lymphoma or primary lung cancer and thoracoscopic surgery was planned to perform. Since the intraoperative frozen section diagnosis was adenocarcinoma, right lower lobectomy and systemic lymph node dissection were performed. However, the final pathology revealed that the lesion was breast cancer metastasis and subcarinal lymph nodes were also positive for metastases.

[Early Resuming of Continuous Ambulatory Peritoneal Dialysis on the Following Day After Surgery for Pleuroperitoneal Communication:Report of a Case].

A 72-year-old man was introduced continuous ambulatory peritoneal dialysis (CAPD) for chronic renal failure. Five months later, he was pointed out a massive right pleural effusion. Being diagnosed with pleuroperitoneal communication, he was referred to our department for surgery. Dialysis fluid and indocyanine green were injected through a peritoneal catheter for CAPD 30 minutes before surgery. A small fistula was detected by pressing the abdomen and using infrared thoracoscopy. The fistula was sutured and covered with polyglycolic acid sheet and fibrin glue. A day after surgery, CAPD was resumed. He was discharged on the post operative sixth day without any complications.

A new technique to detect communication sites for pleuroperitoneal communication.

Pleuroperitoneal communication is one of the complications for continuous ambulatory peritoneal dialysis. Communication sites, such as defects or bleb-like lesions, are found in the diaphragm, but it is sometimes difficult to detect these sites. We combined the infrared thoracoscopy and negative pressure technique to detect communication sites. We think our new technique will become an alternative option for difficult and complex cases.

Staged removal of artificial patches for thoracic empyema after extrapleural pneumonectomy for diffuse malignant pleural mesothelioma.

A 69-year-old man with occupational exposure to asbestos was referred to our hospital with right diffuse malignant pleural mesothelioma. He underwent extrapleural pneumonectomy with reconstruction of the pericardium and diaphragm using elongated polytetrafluoroethylene patches, followed by postoperative chemotherapy and chest wall irradiation. One year later, he was hospitalized because of a right empyema caused by Escherichia coli infection. As chest drainage and systemic antibiotics did not eliminate the abscess around the artificial patches, a Clagett window was created. To avoid mediastinal and liver overshift into the right thoracic cavity, we only performed partial resection of the diaphragm patch and incision of the artificial pericardium. After 19 days of irrigation and dressing change, the artificial patches were completely removed. Two months later, the patient provided a culture-negative sample and had an improved nutritional status; we therefore performed closure of the Clagett window with thoracoplasty. He did not experience recurrence of empyema.

[Successful Negative Pressure Wound Therapy for Pleural Empyema by Closing Bronchopleural Fistula with Cyanoacrylate Products].

A 69-year-old man had experienced right upper lobectomy for inflammatory granuloma. Three months after surgery, he was diagnosed with pleural empyema due to bronchopleural fistula and open window thoracostomy was performed. Since we could not decrease the dead space and the amount of pleural effusion, we introduced negative pressure wound therapy (NPWT). Before applying, we closed the fistula with suturing and cyanoacrylate products. Four weeks later, we performed an operation to close the open window with muscle transposition. NPWT is reported to be useful to treat pleural empyema, but control the air leakage from fistulas is essential to introduce this treatment. We think cyanoacrylate products may be useful in closing fistulas temporarily to introduce NPWT.

[Surgery for Right Pulmonary Arteriovenous Malformation with Recurrent Brain Abscess:Report of a Case].

A 68-year-old man was referred to our hospital for further examination for chest abnormal shadow in the right lung field. He had a past history of subarachnoid hemorrhage. He was diagnosed with pulmonary arteriovenous malformation (PAVM) and recommended early treatment, but he didnot accept immediate surgical treatment. Three months later, he was transferred to other hospital emergently to treat nausea and dizziness. After being diagnosed with cerebellum abscess, external drainage was performed at our hospital. First drainage had a temporary efficacy, so second drainage was performed before referring to our department. Considering his condition and brain abscess, surgery for PAVM was done.

[Pulmonary Blastoma with the Differentiation of Adenocarcinoma and Large Cell Neuroendocrine Carcinoma in an Adult Patient;Report of a Case].

A 63-year-old man was pointed out a mass lesion in his chest X-ray at a medical checkup and referred to our hospital for further examination. Chest computed tomography showed a 4 cm-diameter tumor in the left upper lobe. He was diagnosed with adenocarcinoma by bronchoscopic biopsy. Therefore, we performed left upper lobectomy. The tumor was diagnosed as pulmonary blastoma with the differentiation of adenocarcinoma and large cell neuroendocrine carcinoma.

[Segmentectomy for Congenital Left Upper Lobar Bronchial Atresia].

A 22-year-old woman visited a hospital to treat her dyspnea which had lasted for some months. Chest X-ray showed hyperlucency in her left upper lung field and chest computed tomography suggested left upper bronchial obstruction with mucoid impaction. She was referred to our hospital for further examination and treatment. Bronchoscopy showed left upper lobar bronchial atresia. Considering her dyspnea worsened in relatively short terms, surgical treatment was chosen and the resection of left upper division was successfully performed.

[Ectopic Hilar Thymoma Associated with Morvan Syndrome after Extended Thymectomy for Myasthenia Gravis].

Morvan syndrome is a rare autoimmune neurological disease characterized by peripheral nerve hyperexcitability, autonomic dysfunction and encephalopathy. Morvan syndrome is often associated with thymoma as a paraneoplastic condition. Here we present a rare case of Morvan syndrome with ectopic hilar thymoma after extended thymectomy for myasthenia gravis.

[Metastatic Atypical Meningioma of the Lung;Report of a Case].

A 56-years-old woman, who had undergone a complete resection for atypical meningioma (grade 2 of World Health Organization classification)8 years before was admitted to our hospital to treat a mass on the right middle lobe detected by chest X-ray. The mass was resected successfully by video-assisted thoracoscopic surgery and pathological diagnosis of the tumor was a metastatic atypical meningioma. We experienced a rare case of extracranial pulmonary metastasis of meningioma. Grade 2 meningioma is thought to have malignant potential of local recurrence and extracranial metastasis compared to grade 1 meningioma, so long-term observation may be necessary after resection of atypical meningioma.

Challenging Differential Diagnosis of Hypergastremia and Hyperglucagonemia with Chronic Renal Failure: Report of a Case with Multiple Endocrine Neoplasia Type 1.

A 53-year-old woman developed end-stage renal failure during a 15-year clinical course of primary hyperparathyroidism and was referred to our hospital for evaluation of suspected multiple endocrine neoplasia type 1 (MEN1). Genetic testing revealed a novel deletion mutation at codon 467 in exon 10 of the MEN1 gene. Systemic and selective arterial calcium injection (SACI) testing revealed hyperglucagonemia and hypergastrinemia with positive gastrin responses. A pathological examination revealed glucagonoma and a lymph node gastrinoma. The findings in this case indicate the importance of early diagnosis of MEN1 and demonstrate the utility of systemic and SACI testing in renal failure cases.

[Gastrointestinal Stromal Tumor with Metastasis of Chest Wall and Both Lungs].

A 60-years-old male, who had undergone surgery for gastrointestinal stromal tumor of small intestine 8 years before, was admitted to our hospital for surgical treatment of left 10th rib metastasis. Three months after the 1st operation new metastatic lesions appeared at hypodermic tissue at right anterior chest wall and left upper lobe of the lung and we performed 2nd operation to resect these lesions. Five months after 2nd operation, we performed 3rd operation to resect another metastatic pulmonary lesion at right upper lobe.

[Pulmonary Metastasis of Sacral Chordoma Fifteen Years after Resection of Primary Site;Report of a Case].

A 71-years-old man, who had undergone resection for sacral chordoma 15 years before, was admitted to our hospital to treat a nodule in the right middle lobe detected by computed tomography. The nodule was resected and was histologically diagnosed as lung-metastasis of chordoma.

[Metastatic Ovarian Granulosa Cell Tumor of the Diaphragm Resected by Video-assisted Thoracoscopic Surgery;Report of a Case].

A 75-years-old woman, who had undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy for ovarian granulosa cell tumor( OGCT) 6 years ago, was admitted to our hospital to treat a mass on the right diaphragm detected by computed tomography. The mass was resected successfully by video-assisted thoracoscopic surgery and pathological diagnosis of the tumor was a metastatic OGCT of the diaphragm. To our knowledge, this is the 3rd case report of metastatic OGCT of the diaphragm.

[Open Drainage for Mediastinitis after Endobronchial Ultrasonography-guided Transbronchial Needle Aspiration].

A 61-year-old man had been diagnosed as lung cancer (cT4N2M0, stage IIIB) and radiochemotherapy was performed. After the treatment, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was done to identify the histrogical type and to detect the oncogenic driver mutation. After EBUS-TBNA, he developed a high grade fever and the findings of the chest computed tomography (CT) suggested the infection of puncture site in mediastinum. Symptoms disappeared once by oral and intravenous antibiotics, but the infection recurred again. Chest CT revealed an abscess cavity with possible communication to the airway. Open drainage and debridment were performed and the anticancer chemotherapy could be continued.

[Rib Metastasis from Intracranial Hemangiopericytoma: Report of a Case].

A 65-year-old man had undergone the surgical treatment for intracranial hemangiopericytoma(HPC) in 2011. In June 2013, the X-ray abnormality in health examination was pointed out. Chest Computed tomography shows a 30 mm-sized tumor lesion with bone destruction in the 6th left rib bone. Fluorodeoxyglucose-positron emission tomography revealed no lesion except for the tumor. Surgical resection of the rib tumor was performed in July 2013. Pathologically it was diagnosed as bone metastasis of HPC. The postoperative course was uneventful, but multiple bone metastases were found 6 months after surgery.

[Solitary Mediastinal Lymph Node Metastasis From Hepatocellular Carcinoma].

A 40-years-old Japanese female suffering from misswallowing and hoarseness, who had undergone hepatectomy due to hepatocellular carcinoma(HCC) 4 years before, revealed solitary subaortic mass in the chest computed tomography scan and fluorodeoxyglucose-positron emission tomography. The mass was surgically resected by video assisted thoracoscopic surgery and pathological examination revealed lymph node metastasis of HCC. Symptoms of recurrent nerve palsy disappeared after surgery.

[Subpectoral lipoma developing to cervix; report of a case].

A 54-year-old Japanese female, who presented slight swelling of the supraclavicular region due to soft indolent mass without neurological impairment, was admitted to our hospital to receive surgical treatment. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed subpectoral mass surrounded by the minor pectoral muscle, the subscaplar muscle, and the bony thorax, and spread to cervix passing through between the right clavicle and the bony thorax, indicating similarity of the intensity and the density to subcutaneous fatty tissue, and then the mass was guessed to be extremely rare subpectoral lipoma. The lipoma was dissected successfully from adjacent subclavian artery and vein, brachial nerve, and surrounding muscles through sub-and supra-clavicular small skin incision without cut of the clavicle. Subpectoral lipoma is one of the benign tumor and at the operation less invasive and cosmetically superior approach should be adopted except for inevitable cases.