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Interstitial pneumonia and recurrent pneumothorax developed in a 48-year-old man who had worked as a metal grinder. He died of respiratory failure despite having received antibiotics and steroids, and despite having undergone pleural sclerosis therapy. Giant cell interstitial pneumonia was diagnosed; innumerable bizarre giant cells engulfing black granules were found within the alveoli. The results of high-energy dispersion X-ray microanalysis indicated that the patient had hard metal pneumoconiosis associated with tungsten in the black granules. When he was admitted to the hospital, his serum CA19-9 and SLEX concentrations were abnormally high (2600 and 200 ng/ml, respectively). Immunohistochemical analysis of lung tissue was done with anti-CA19-9 and SLEX antibodies. CA19-9 staining revealed strong bronchialization and squamous metaplasia in contrast to type II hyperplasia. SLEX staining showed strong type II hyperplasia. Further investigations will be needed to determine the mechanism of elevated tumor-associated carbohydrate antigens in serum.

A 26-year-old man was admitted to our hospital for evaluation of cavitary lesions on his chest X-ray film. Chest CT and conventional tomograms showed multiple cavities in both lung fields, as well as hilar and mediastinal lymphadenopathy. He had uveitis and the laboratory data showed a high level of angiotensin converting enzyme in the serum. Histological findings of the specimen obtained by transbronchial lung biopsy showed non-caseating epithelioid cell granuloma, consistent with sarcoidosis. Corticosteroid therapy (prednisolone 40 mg/day) resulted in reduction of the cavitary lesions and the lymphadenopathy. Negative bacteriological studies and the clinical course strongly suggested primary cavitation, a relatively rare form of pulmonary parenchymal involvement in sarcoidosis.

A 60-year-old man was admitted to our department for investigation of abnormal shadows on his chest X-ray. He had been diagnosed as having neurilemmomatosis in 1987. His chest X-ray showed nodular shadows in left S5 and S8 and localized spontaneous pneumothorax in left lung field. The nodular shadows, which were in contact with thickening of the pleura, showed curved shadows of bronchi and vessels (so-called comet tail sign). We suspected that they were round atelectasis, but to confirm the diagnosis and to treat the pneumothorax, limited resection of the lung and resection of the bulla were performed. The diagnosis of round atelectasis was confirmed by histological findings. Round atelectasis related to spontaneous pneumothorax is a very rare condition; however, we consider this to be an important case for understanding the pathogenesis of round atelectasis.

A 59-year-old female was admitted for spontaneous pneumothorax. After evacuation, the chest X-ray film showed a round mass lesion at the left hilum. Following curettage and bronchoalveolar lavage of the left B3c, the mass became smaller, suggesting the diagnosis of round atelectasis. This is the first report of round atelectasis complicated by spontaneous pneumothorax. The mechanism of this case is suggested to resemble that of round atelectasis associated with pleural effusion.

A 14-year-old girl was admitted because of cough, chest pain and hemosputum. Chest roentgenogram on admission showed a pneumothorax and a cavitary lesion with niveau formation in the right lung and cystic lesions in the bilateral lung fields. After bed rest and intravenous administration of antibiotics for two weeks, the right lung inflated well and the niveau formation disappeared, and the patient was discharged. One week later, she was readmitted with sudden-onset severe dyspnea, caused by bilateral pneumothoraces. Emergency tube thoracostomy and wedge resection of the bullous lesion was performed. Macroscopically, multiple small cystic changes were seen on the surface of the right lung. Histological examination revealed nodular proliferations of smooth muscle cells in the interstitium and vessel walls in the lung, which contained slit-like lymphatic channels. The diagnosis of pulmonary lymphangiomyomatosis was made. In this case, we could not measure receptors for estrogen and progesterone. Recently, hormonal therapy and oophorectomy have been reported as being useful. Tamoxifen (Norvadex) was therefore initiated, and the patient has remained well with slight dyspnea on exertion. There has been no recurrence of pneumothorax. Lymphangiomyomatosis is a rare disease of unknown etiology which occurs exclusively in women, mostly in those of reproductive age. We report a 14-year-old female patient with lymphangiomyomatosis associated with repeated pneumothorax, who had been under treatment for epilepsy. We believe this case to be of importance because of the long discussed relation between pulmonary lymphangiomyomatosis and tuberous sclerosis.

A case of mediastinitis and left pyopneumothorax complicating a laryngeal phlegmon caused by Candida albicans is described. A 64-year-old woman was admitted complaining of pharyngeal pain, hoarseness, dysphagia, and pain behind the left angle of the mandible. In that hospital, she was diagnosed as having a laryngeal phlegmon. She was known to be diabetic and hypertensive since 54 years of age. After admission, she became dyspneic, and chest X-rays revealed left atelectasis, left pleural effusion and left pneumothorax. After a drain was inserted into the left thoracic cavity, she was transferred to our hospital. Chest X-rays showed widening of the mediastinum, an enlarged cardiac shadow, mediastinal emphysema, left pneumothorax and bilateral pleural effusion. A thoracic CT also showed extensive mediastinal emphysema. On March 19, 1988 we incised the abscess behind the left angle of the mandible and inserted drains into both the mediastinum and left thoracic cavity under general anesthesia. Candidiasis was diagnosed based on culture of pus obtained from the abscess behind the left angle of the mandible. She was treated with antibiotics intravenously and through both drainage tubes for about 1 month. She was cured and discharged after 5 months of hospitalization.