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Patients after lung transplantation are at risk for postoperative malignancy mainly due to postoperative immunosuppression. Skin cancer and post-transplant lymphoproliferative disorder (PTLD) are common in Western countries. We retrospectively reviewed the medical records of 120 patients undergoing lung transplantation between April 2002 and July 2015 at Kyoto University. Postoperative malignancy developed in 14 patients(11.7%):PTLD in 8, gastric cancer in 2, breast cancer in 1, glioblastoma in 1, lung cancer in 1, and adenocarcinoma of unknown primary in 1. Seven patients(11.3%)and 7 patients (12.1%)were after living-donor lung transplantation( LDLLT) and cadaveric lung transplantation (CLT), respectively (p=1.00). The overall 5-year survival of patients with postoperative malignancy was 39.3%, which tended to be worse (p=0.059), compared to those without postoperative malignancy(71.4%). All postoperative malignancies were de novo malignancies without any recurrence of original malignancies. Postoperative malignancies occurred after LDLLT as well as after CLT, and seemed to have a negative impact on long-term outcome of lung transplant recipients. The majority was PTLD;however, skin cancer was not recognized, suggesting ethnic differences. We should be careful about postoperative malignancies in follow-up of the lung transplant recipients.

A bilateral hilar lymphadenopathy on the chest radiograph of a 30-year-old man was pointed out in a medical examination. Four months later, he was admitted to our hospital because of exacerbation of a bilateral hilar lymphadenopathy on the chest radiograph with high fever. Physical examination revealed a marked swelling of the face and upper arms as well as a dilated jugular vein. The fever, which was his chief complaint, responded to antibiotic therapy. A CT scan of the chest confirmed the presence of bilateral mediastinal lymphadenopathy and hilar lymphadenopathy, which caused pulmonary artery and superior vena cava stenosis. A superior vena cavagram demonstrated narrowing of the vessel. Mediastinoscopy was performed for definite diagnosis. Pathologic examination of the specimen revealed noncaseating epithelioid cell granuloma consistent with sarcoidosis. He was asymptomatic. Pulmonary function and arterial blood gas studies yielded almost normal results. A roentgenographic stage of intrathoracic change was Stage I. On the basis of these findings, he was observed carefully without systemic corticosteroid therapy. One month later, the swelling of his face and upper arms was improved, and the pulmonary functions and arterial blood gases remained almost normal. Only seven cases of sarcoidosis causing superior vena cava syndrome have been reported. This is the first case reported in Japan.