Assessing recurrence of depression using a zero-inflated negative binomial model: A secondary analysis of lifelog data.

When studying recurrence of depression, researchers should pay attention to cases where physicians' assessment corresponds to the patients' perception. However, they should also focus on potential signs of recurrence when the recurrence is suspected by the physicians but not the patients (false-negative zeros). Because false negatives can delay diagnosis and treatment, we aimed to investigate "sitting idly" as a predictor influencing no alert sign of recurrence and estimated the counts of recurrence of depression. A smartphone application and a wearable device were used to collect lifelog data from 89 remitted depressive patients over one year. Recurrent depression was defined using the Japanese version of the Kessler Psychological Distress Scale and Patient Health Questionnaire-9 scores. Estimates of the population-averaged parameters indicated that daily hours of sitting idly increased the chances of recurrent depression occurring two to four weeks later. Exposure to daily ultraviolet light reduced depression relapse. Although long sleep was a determinant of zero outcome of the recurrence of depression after two to four weeks, daily hours of sitting idly can negate it. Thus, daily hours of sitting idly could reduce overdispersion of the recurrence of depression, and we could measure recurrent depression accurately by considering changes in sitting idly.

Predicting recurrence of depression using lifelog data: an explanatory feasibility study with a panel VAR approach.

BACKGROUND: Although depression has a high rate of recurrence, no prior studies have established a method that could identify the warning signs of its recurrence. METHODS: We collected digital data consisting of individual activity records such as location or mobility information (lifelog data) from 89 patients who were on maintenance therapy for depression for a year, using a smartphone application and a wearable device. We assessed depression and its recurrence using both the Kessler Psychological Distress Scale (K6) and the Patient Health Questionnaire-9. RESULTS: A panel vector autoregressive analysis indicated that long sleep time was a important risk factor for the recurrence of depression. Long sleep predicted the recurrence of depression after 3 weeks. CONCLUSIONS: The panel vector autoregressive approach can identify the warning signs of depression recurrence; however, the convenient sampling of the present cohort may limit the scope towards drawing a generalised conclusion.

Cognitive and Behavioral Skills Exercises Completed by Patients with Major Depression During Smartphone Cognitive Behavioral Therapy: Secondary Analysis of a Randomized Controlled Trial.

BACKGROUND: A strong and growing body of evidence has demonstrated the effectiveness of cognitive behavioral therapy (CBT), either face-to-face, in person, or as self-help via the Internet, for depression. However, CBT is a complex intervention consisting of several putatively effective components, and how each component may or may not contribute to the overall effectiveness of CBT is poorly understood. OBJECTIVE: The aim of this study was to investigate how the users of smartphone CBT use and benefit from various components of the program. METHODS: This is a secondary analysis from a 9-week, single-blind, randomized controlled trial that has demonstrated the effectiveness of adjunctive use of smartphone CBT (Kokoro-App) over antidepressant pharmacotherapy alone among patients with drug-resistant major depressive disorder (total n=164, standardized mean difference in depression severity at week 9=0.40, J Med Internet Res). Kokoro-App consists of three cognitive behavioral skills of self-monitoring, behavioral activation, and cognitive restructuring, with corresponding worksheets to fill in. All activities of the participants learning each session of the program and completing each worksheet were uploaded onto Kokoro-Web, which each patient could use for self-check. We examined what use characteristics differentiated the more successful users of the CBT app from the less successful ones, split at the median of change in depression severity. RESULTS: A total of 81 patients with major depression were allocated to the smartphone CBT. On average, they completed 7.0 (standard deviation [SD] 1.4) out of 8 sessions of the program; it took them 10.8 (SD 4.2) days to complete one session, during which they spent 62 min (SD 96) on the app. There were no statistically significant differences in the number of sessions completed, time spent for the program, or the number of completed self-monitoring worksheets between the beneficiaries and the nonbeneficiaries. However, the former completed more behavioral activation tasks, engaged in different types of activities, and also filled in more cognitive restructuring worksheets than the latter. Activities such as "test-drive a new car," "go to a coffee shop after lunch," or "call up an old friend" were found to be particularly rewarding. All cognitive restructuring strategies were found to significantly decrease the distress level, with "What would be your advice to a friend who has a similar problem?" found more helpful than some other strategies. CONCLUSIONS: The CBT program offered via smartphone and connected to the remote server is not only effective in alleviating depression but also opens a new avenue in gathering information of what and how each participant may utilize the program. The activities and strategies found useful in this analysis will provide valuable information in brush-ups of the program itself and of mobile health (mHealth) in general. TRIAL REGISTRATION: Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000015984 (Archived by WebCite at http://www.webcitation.org/6u6pxVwik).

[Long-Term Survival in Response to Multimodality Therapy in a Patient with Invasive Pancreatic Cancer with Cyst Formation].

The patient was a 61-year-old man. Computed tomography(CT)in April 2007 revealed a pancreatic cyst in the tail of the pancreas. Rapid enlargement was noted in November 2007, and the patient was referred to the surgery department. CT showed a cystic lesion containing a nodular shadow in the pancreatic tail. Tumor marker measurements yielded normal carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)levels, but the duke pancreatic monoclonal antigen type 2(DUPAN-2)level was elevated. A diagnosis of mucinous cystic neoplasm(MCN)of the pancreas was made in December 2007, and distal pancreatectomy and partial colectomy were performed. The pathological diagnosis was a mucinous pancreatic cyst in the pancreatic tail and a moderately differentiated tubular adenocarcinoma that had invaded the spleen and serosal adipose tissue of the transverse colon. No clear ovarian-type stroma was detected, and there was no definitive evidence of MCN. The postoperative course was favorable and complication-free, and gemcitabine postoperative adjuvant therapy was administered. A metastasis was detected in the left lung in April 2011, and was excised. Chemotherapy was administered to the fifth-line, but the patient died of his cancer in August 2015, 7 years and 8 months after the initial surgery, and 4 years and 8 months after the detection of the lung metastasis. MCN and intraductal papillary mucinous neoplasm(IPMN)are typical mucus-producing pancreatic tumors, and they have a relatively good prognosis. Our patient had an invasive cancer associated with a mucinous pancreatic cyst, but no definitive diagnosis was made, and it was considered IPMN. The long-term survival appeared to have been achieved because of subsequent multimodality therapy.

Epidemiological evidence of lesser role of thermostable direct hemolysin (TDH)-related hemolysin (TRH) than TDH on Vibrio parahaemolyticus pathogenicity.

Vibrio parahaemolyticus carrying the tdh gene, encoding the thermostable direct hemolysin (TDH), or the trh gene, encoding the TDH-related hemolysin (TRH), are both considered virulent strains. There are, however, disproportionally fewer reports of infections caused by seafood contaminated with trh-positive strains than by seafood contaminated with tdh-positive strains. Bivalves such as clams and oysters are the major seafood varieties associated with the infections. In this study, the prevalence of strains possessing the tdh and trh genes was investigated in Japan in 74 samples collected in 2007-2008 and in 177 samples collected in 2010 of domestic bivalves, bloody clams, hen clams, short-neck clams, and rock oysters. The tdh-positive and trh-negative, tdh-negative and trh-positive, and tdh-positive and trh-positive samples represented 5.4%, 12.2%, and 4.1% of all samples collected in 2007-2008, and 5.1%, 18.6%, and 5.6% of all samples collected in 2010, respectively. As determined by polymerase chain reaction, the prevalence of tdh negative and trh positive in all samples was two to four times higher than that of tdh positive and trh negative. In the samples collected in 2010, the tdh-negative and trh-positive V. parahaemolyticus (20 samples) was more often isolated than tdh-positive and trh-negative V. parahaemolyticus (7 samples). The most common serotype of tdh-positive isolates (22 of 24 strains) was pandemic O3:K6. The trh-positive isolates (61 strains) were various serotypes including OUT:KUT. In 330 V. parahaemolyticus outbreaks and sporadic infections in Japan, most outbreaks and sporadic infections were caused by tdh-positive and trh-negative strains (89.4%). The frequencies of infections caused by tdh-negative and trh-positive, and both tdh- and trh-positive strains were 1.2% and 3.0%, respectively. This finding suggests that the virulence of trh might be less than that of tdh, although trh-positive V. parahaemolyticus frequently contaminated bivalves.

[R0 Resection of Locally Advanced Pancreatic Cancer after Combination Chemotherapy with Gemcitabine and S-1].

A 68-year-old female was referred to our institution in October 2014 for additional therapy for cancer of the head of the pancreas. Utilizing a computed tomography scan, he was initially diagnosed with locally advanced unresectable cancer because of massive invasion to the superior mesenteric artery (SMA). Combination chemotherapy consisting of gemcitabine and S-1 was administrated for 10 months. Since the tumor was remarkably reduced after chemotherapy, pancreaticoduodenectomy combined with portal vein resection was performed. Since the histopathological findings indicated few residual cancer tissues, our chemotherapy was considered dramatically effective. The postoperative course was uneventful and the patient remains well and without any recurrences 14 months after the surgery. We therefore report a case of locally unresectable pancreatic cancer, which achieved R0 resection after combination chemotherapy with gemcitabine and S-1.

[R0 Resection by Distal Pancreatectomy with En Bloc Celiac Axis Resection after Down-Staging by FOLFIRINOX Therapy in a Case of Pancreas Cancer--Report of a Case].

The patient, a 55-year-old man, was diagnosed elsewhere as having cancer of the tail of the pancreas and was referred to our hospital. Abdominal computed tomography (CT) revealed a remarkably large tumor, 90 mm in diameter, in the tail of the pancreas, with invasion of the adjacent spleen, stomach, left adrenal gland, diaphragm, and celiac artery; metastasis to the liver; and peritoneal dissemination. The serum levels of the tumor markers CEA and CA19-9 were elevated (21.2 ng/mL and 9,530 U/mL, respectively). Since surgery was not considered to be feasible in this condition, the patient was started on FOLFIRINOX therapy. Adverse events, including Grade 3 decreased neutrophil count, anorexia, diarrhea, and hyperkalemia occurred; however, the patient was able to receive 10 cycles of therapy with downward adjustments of the dosage. In response to the therapy, the tumor marker levels fell rapidly, and on CT, the tumor shrank to 40 mm in diameter; however, resection was still scheduled because positron emission tomography (PET)-CT revealed suspected remnants of the disease in the pancreatic tail. After preoperative transcatheter embolization of the common hepatic artery and the left gastric artery, distal pancreatectomy with en bloc celiac axis resection (DP-CAR) was performed. Intraoperative ultrasonography revealed no metastatic lesions in the liver. Histopathologically, the resected sites were found to be almost totally replaced with fibrous scar tissue, and only trace evidence of moderately differentiated tubular adenocarcinoma components were seen in the pancreatic tail, gastric submucosa, and left adrenal gland. Therefore, R0 resection had been achieved. The patient remains alive, showing no signs of recurrence at 18 months after the initial treatment and 11 months after the tumor resection. The results in this case suggest that FOLFIRINOX therapy can increase the radical curability of pancreatic cancer via down-staging and eventually improve the prognosis.

[A Case of Anal Canal Cancer Treated by Abdominoperineal Resection in a 100-Year-Old Woman].

A 100-year-old woman visited our hospital because of erosion and bleeding in her anal region in January 2014. Computed tomography scans revealed the presence of a tumor in the anal canal, which caused a considerable amount of pain and bleeding over the next 4 months. Accordingly, immediate surgical intervention was considered necessary to provide local control. Therefore, we decided to perform abdominoperitoneal resection after consultation with her family. The operation was successfully completed, and histopathological examination indicated a diagnosis of adenocarcinoma of the anal canal. The postoperative course was almost uneventful, and the patient was discharged on the 23rd post-operative day. There are some cases reported in Japan where laparotomy was performed for patients over 100 years of age, but none of them were treated surgically for anal canal cancer. We suggest that elective surgical intervention can be an effective option for the treatment of abdominal and pelvic malignancies even in patients of an extremely advanced age.

[A case of synchronous triple cancer treated with multidisciplinary therapy - cancers in the middle part of the extrahepatic bile duct, the pancreas head, and the supraglottis].

An 83-year-old man was admitted to our institution for the purpose of investigation of hoarseness in January 2014. He was diagnosed with cancer in the supraglottis via biopsy while undergoing laryngeal microsurgery. Positron emission tomography (PET)evaluation for tumor staging revealed two hot spots, 1 in the hepatoduodenal ligament and 1 in the pancreas head. Accordingly, the patient was diagnosed with synchronous double cancer in the middle bile duct and the pancreas head. The treatment of the bile duct cancer and pancreatic cancer was performed prior to that of the supraglottic cancer. Curative pancreatoduodenectomy was performed, and the postoperative course was uneventful. Three weeks after the surgery, chemoradiotherapy for the supraglottic lesion was initiated. The tumor almost disappeared 2 months after the start of chemoradiotherapy, as observed by using a laryngoscope. Multidisciplinary therapy based on the therapeutic guidelines for each of the cancers was beneficial for the patient.

Differences in the stress tolerances of Vibrio parahaemolyticus strains due to their source and harboring of virulence genes.

To investigate the diversity of stress tolerance levels in Vibrio parahaemolyticus, 200 V. parahaemolyticus strains isolated from various coastal environments, seafood, and human clinical cases were exposed to acid, low-osmolality, freezing-thawing, and heat stresses. Tolerance against acid stress was higher in the virulent (tdh- and/or trh-positive) strains than in the avirulent (tdh- and trh-negative) strains. Tolerance against low-osmolality, freezing-thawing, and heat stresses was higher in the clinical strains of tdh- and/or trh-positive V. parahaemolyticus than in the coastal environment- and seafood-originated strains of tdh and/or trh-positive V. parahaemolyticus. Tolerance against acid stress was higher in the strains isolated from coastal seawater at ≤15°C than in the strains isolated at ≥20°C. Tolerance against heat stress was higher in the avirulent strains than the virulent strains, and in the strains isolated from coastal seawater at ≥20°C than the strains isolated from coastal seawater at ≤15°C. Therefore, this study demonstrated that the diversity of stress tolerance levels in V. parahaemolyticus strains depended on their source and whether they harbored virulence genes. In particular, there was significantly greater tolerance against acid in the virulence gene-harboring strains and strains isolated from low-temperature seawater. Because the stress tolerances of V. parahaemolyticus have direct influences for the survival in environment and food, it is important for the prevention of foodborne infection to control the stress-tolerant strains.

[A case of locally advanced gastric cancer in which pathological complete response( PCR) was obtained after combination chemotherapy with S-1/cisplatin].

A 72-year-old man with advanced gastric cancer was referred to our hospital. Upper gastrointestinal endoscopy revealed a type 3 tumor in the gastric antrum and pyloric stenosis. Computed tomography( CT) demonstrated that the tumor had directly infiltrated the pancreatic parenchyma and that the paraaortic lymph nodes were enlarged. We judged the tumor to be unresectable and performed gastrojejunostomy. Postoperatively, the patient was treated with 9 courses of combination chemotherapy comprising S-1 and cisplatin( CDDP), and significant tumor reduction was obtained. Therefore, we performed radical distal gastrectomy with D2 lymphadenectomy. Histological examination revealed a complete absence of cancer cells in the stomach and all of the lymph nodes( pathological complete response: pCR). Seven months after surgery, the patient is in good health with no recurrence. This case suggests that aggressive chemotherapy can be a useful treatment to enable radical surgery for unresectable locally advanced gastric cancer.

[Extended resection for a huge retroperitoneal malignant paraganglioma-a case report].

A 74-year-old man was transferred to our institute because of a huge abdominal tumor in April 2012. Computed tomography (CT) showed the presence of a huge retroperitoneal tumor, 20 cm in diameter. The tumor directly infiltrated the right kidney, the liver, and the inferior vena cava. Obstruction of the hepatic hilum and right hydronephrosis in the near future was predicted, and therefore, immediate surgical intervention was selected. Extracorporeal circulation was essential for complete tumor removal. The tumor was removed en bloc together with the right lobe of the liver, the right kidney, the ileocecal portion, and the retrohepatic vena cava. Histopathological examination indicated a diagnosis of paraganglioma. Two months after surgery, CT showed a recurrent lesion at the resected surface of the pelvic cavity. Additional radiotherapy was ineffective, and the patient died 6 months after surgery.

[A case of hepatocellular carcinoma with biliary tumor thrombi treated by extended hepatectomy].

A 61-year-old male patient visited our hospital because of liver dysfunction. Computed tomography (CT) scan revealed a diffuse tumor in the right lobe of the liver with biliary tumor thrombi extending into the common bile duct. Percutaneous transhepatic biliary drainage(PTBD) was performed for obstructive jaundice. After improvement in the liver function, the patient underwent surgical intervention. Right trisectionectomy with removal of tumor thrombi was selected. Although the postoperative course was uneventful, CT scan demonstrated recurrent nodules in the remnant liver 4 months after surgery. Transcatheter arterial chemoembolization(TACE) was successfully performed for the recurrent lesions. The patient survived without any occurrence of viable lesions in the remnant liver. This case indicates that aggressive and curative surgery may improve the prognosis of patients with hepatocellular carcinoma and biliary tumor thrombi.

[A case of hepatocellular carcinoma treated by resection of metachronous rib metastasis after primary hepatectomy].

A 76-year-old man underwent right hemihepatectomy and partial hepatectomy of segment II for hepatocellular carcinoma (HCC) at our institution. Four months after the primary hepatectomy, the patient complained of severe back pain on the right side, and computed tomography and bone scintigraphy indicated metastasis of the eighth rib on the right side. Because no metastatic lesions were observed in any organ, the patient underwent surgical intervention for the rib metastasis in December 2011. Histopathological findings confirmed that the metastatic tumor originated from the HCC and that cancer tissues were absent from the surgical margins. Postoperative radiotherapy was additionally performed for preventing local recurrence. The sharp cancerous pain disappeared completely, and the patient was lived without recurrence 6 months after the second surgery. In cases where intrahepatic or other metastatic lesions are controllable and only a solitary bone metastatic lesion is evident, surgical resection is effective in HCC patients with bone metastasis.

Histopathological and immunohistochemical findings of 20 autopsy cases with 2009 H1N1 virus infection.

Twenty autopsy cases with 2009 pandemic influenza A (2009 H1N1) virus infection, performed between August 2009 and February 2010, were histopathologically analyzed. Hematoxylin-eosin staining, immunohistochemistry for type A influenza nucleoprotein antigen, and real-time reverse transcription-PCR assay for viral RNA were performed on formalin-fixed and paraffin-embedded specimens. In addition, the D222G amino acid substitution in influenza virus hemagglutinin, which binds to specific cell receptors, was analyzed in formalin-fixed and paraffin-embedded trachea and lung sections by direct sequencing of PCR-amplified products. There were several histopathological patterns in the lung according to the most remarkable findings in each case: acute diffuse alveolar damage (DAD) with a hyaline membrane (four cases), organized DAD (one case), acute massive intra-alveolar edema with variable degrees of hemorrhage (three cases), neutrophilic bronchopneumonia (five cases) and tracheobronchitis with limited histopathological changes in alveoli (four cases). In two cases, the main findings were due to preexisting disease. Influenza virus antigen was only detected in the respiratory tract in 10 cases by immunohistochemistry. The antigen was detected in type II pneumocytes (three cases) in the epithelial cells of the trachea, bronchi and glands (six cases), and in the epithelial cells in both of the above (one case). The four cases with acute DAD presented with antigen-positive type II pneumocytes. In one case, the D222G substitution was detected in the lung as a major sequence, although 222D was prominent in the trachea, suggesting that selection of the viral clones occurred in the respiratory tract. In five cases, the pathogenesis of 2009 H1N1 was confirmed to be viral infection in pneumocytes, which caused severe alveolar damage and fatal viral pneumonia. Further studies on both host and viral factors in autopsy or biopsy materials will be essential to elucidate the other pathogenic factors involved in influenza virus infection.

[A case of recurrent intra-abdominal pediatric desmoid tumor undergoing surgical intervention for 6 times].

A 15-year-old male patient with palpable abdominal tumor presented to our hospital. CT scan revealed a giant tumor, 15 cm in diameter, with infiltration to the pancreas body. In addition, the tumor invaded to the greater curvature of the stomach and the transverse colon. We performed distal gastrectomy, distal pancreatectomy, splenectomy and transverse colectomy. The final diagnosis of histopathology was desmoid tumor. The tumor recurred locally 9 months after the surgery. Recurrent legion was unresectable because of the invasion to the orifice of SMV and weekly combination chemotherapy of VLB and MTX was started. Although a partial response was achieved for a local recurrent legion after 20 courses, CT scan showed other new recurrent multiple lesions in the abdominal cavity. Due to the severe abdominal discomfort and intestinal obstruction, a reduction surgery was performed 5 times in total. Endocrine therapy and administration of NSAID were not effective. Tumor progression was uncontrollable, and the patient died 5 years and 8 months after the initial surgery.

Survival of Salmonella strains differing in their biofilm-formation capability upon exposure to hydrochloric and acetic acid and to high salt.

Acidic and osmotic treatments are part of hurdle systems to control pathogens such as Salmonella in food. In the current study, Salmonella enterica isolates previously shown to differ in their ability to form biofilms were grown in diluted tryptic soy broth (TSB) (1:5 dilution in distilled water) and subsequently exposed to phosphate-buffered saline (PBS) adjusted to pH 3.0 with HCl, PBS adjusted to pH 3.9 with acetic acid or rice vinegar diluted 1:15 with distilled water (pH 3.9). Cells grown in diluted TSB were also exposed to distilled water, pH 7.6, containing 5 M NaCl. No differences in survival upon exposure to PBS adjusted to pH 3.0 with HCl or distilled water containing high salt were observed between the isolates; however, exposure to acetic acid and rice vinegar resulted in lower survival levels of isolates previously shown to be poor biofilm formers. The numbers (log(10) cfu/ml) of surviving cells after exposure for 36 hr to acetic acid and rice vinegar were 4.43 ± 0.24 vs. 2.27 ± 0.87 (P<0.05) and 5.19 ± 0.12 vs. 2.33 ± 0.93 (P<0.05) for isolates with a high vs. low biofilm-forming ability. The survival data could be fitted with the Weibull model. The data suggest that the ability of Salmonella strains to survive in the presence of acetic acid and rice vinegar parallels their ability to form biofilms. Thus, Salmonella with a high biofilm-formation capability might be more difficult to kill with acetic acid found in foods or cleaning solutions.

Survival of Salmonella on a polypropylene surface under dry conditions in relation to biofilm-formation capability.

This study was conducted to gain insights into the survival of Salmonella on a polypropylene surface in relation to the ability of these bacteria to form a biofilm. We selected Salmonella strains known for the relative ease or difficulty with which they formed biofilms based on microtiter plate assays and studied the survival of these strains on polypropylene discs in a desiccation chamber by sequentially counting CFUs. The biofilm-forming strains survived longer on the plastic disc surface than did biofilm-deficient strains. The biofilm-forming strains remained at over 10(4) CFU per plate until day 175, whereas the biofilm-deficient strains decreased to below 10(2) CFU per plate on day 20 or below 10(4) CFU per plate on day 108. Extracellular materials on the polypropylene surface were observed by scanning electron microscopy and crystal violet staining for the biofilm-forming strains but not for the biofilm-deficient strains. The extracellular polymeric materials on the polypropylene surface may have protected the bacterial cells from dryness, although the possibility of some inherent resistance to environmental stresses linked to biofilm formation could not be excluded. These results indicate that Salmonella strains with high biofilm productivity may be a greater risk to human health via food contamination by surviving for longer periods compared with strains with low biofilm productivity.

Fluorescence in situ hybridization analysis with a tissue microarray: 'FISH and chips' analysis of pathology archives.

Practicing pathologists expect major somatic genetic changes in cancers, because the morphological deviations in the cancers they diagnose are so great that the somatic genetic changes to direct these phenotypes of tumors are supposed to be correspondingly tremendous. Several lines of evidence, especially lines generated by high-throughput genomic sequencing and genome-wide analyses of cancer DNAs are verifying their preoccupations. This article reviews a comprehensive morphological approach to pathology archives that consists of fluorescence in situ hybridization with bacterial artificial chromosome (BAC) probes and screening with tissue microarrays to detect structural changes in chromosomes (copy number alterations and rearrangements) in specimens of human solid tumors. The potential of this approach in the attempt to provide individually tailored medical practice, especially in terms of cancer therapy, is discussed.

A case of juvenile primary pulmonary malignant fibrous histiocytoma.

An 18-year-old female presented with an abnormal shadow of a 22-mm nodule in the left anterior segment of the upper lung lobe (S3) on chest X-ray and computed tomography (CT). Thoracoscopic partial lobectomy was performed, when a frozen section suggested spindle cell sarcoma of extrapulmonary origin, including malignant fibrous histiocytoma (MFH). A histologic diagnosis of the MFH was rendered postoperatively on permanent sections. As no other primary focus was detected in spite of intensive investigation, including 18F-fluorodeoxyglucose positron emission tomography - CT scans, a definitive diagnosis was made of primary pulmonary MFH. Primary pulmonary MFH is usually treated by total resection, however, in the current case we performed a partial lobectomy with clear margins and a watchful follow-up without any additional aggressive treatment. No relapse has been observed for 3 years after the surgery.