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The aim of this study was to investigate the influence of a history of diabetes mellitus (DM) and the glycated hemoglobin (HbA1c) level on the survival in patients who underwent complete resection for non-small cell lung cancer (NSCLC). Of the patients who underwent complete resection for NSCLC between 2007 and 2015, 468 were classified into DM (who were currently taking medication for DM) and no DM groups as well as into high HbA1c (≥ 6.5) and normal HbA1c (

A 63-year-old man who had received a permanent tracheostoma after oesophageal cancer surgery developed fistulas in the left and right main bronchi and suffered repeated aspiration pneumonia. Placing an indwelling Dumon Y-stent using a rigid bronchoscope is an option to treat fistula and stenosis at the tracheal bifurcation, but in some cases, it may be difficult to use a rigid bronchoscope in patients with a permanent tracheostoma. In this study, we report placing a Dumon Y-stent in a patient with a permanent tracheostoma using a specially modified stent and forceps instead of a rigid bronchoscope.

Schwannomas are the most frequent type of intrathoracic neurogenic tumour, but the presence of multiple simultaneous schwannomas is a rare occurrence. We experienced a patient initially thought to have a single schwannoma based on preoperative imaging, but who was subsequently found to have two adjacent schwannomas arising from different nerves. A 48-year-old woman showed an abnormal shadow on chest X-ray during a medical examination. CT-guided biopsy did not provide a definitive diagnosis, and she was therefore referred to our department. Her general condition was good and her neurological findings were normal. No skin pigmentation or subcutaneous nodules were observed. Chest CT revealed a 5.5 cm segmental lobular tumour in the right posterior mediastinum (figure 1A) and chest MRI showed that the tumour continued from the right …

A linear stapler with bioabsorbable polyglycolic acid felt is widely used during the resection of emphysematous lung. Currently, an improved staple device with polyglycolic acid felt is being used owing to a history of complications, such as bleeding, that was associated with the previous model. Here, we report a case of a 69-year-old man who presented to our department for treatment of left lower lobe lung cancer using the new staple device. A left lower lobectomy and emphysematous bullectomy were performed. Reoperation was performed following the diagnosis of a postoperative hemothorax. During that operation, a staple with reinforcing material was found to be in contact with the proliferating vessels on the lung surface, resulting in an active bleed. The vessel was cauterized, and the bleeding stopped. This is the first case study to report bleeding associated with the improved staple device.

An anterior mediastinal tumor was detected in a 45-year-old female during a medical checkup. Chest computed tomography (CT) showed the anterior mediastinal tumor and a pulmonary tumor in the right lower lobe. Furthermore, tumors of the parathyroid gland, pancreas, and pituitary gland were also detected. She was clinically diagnosed with multiple endocrine neoplasia type1 (MEN1). The patient underwent extended thymectomy combined with mediastinal lymph node dissection and wedge resection of the lung including the right pulmonary lesion via a median sternotomy. We diagnosed the patient with an atypical carcinoid tumor of the thymus, a typical pulmonary carcinoid tumor.

Delirium is a common post-surgical complication, but few studies have examined postoperative delirium following lung cancer surgery. The purpose of this study was to clarify the risk factors of postoperative delirium, to construct a useful scoring system, and to clarify the relationship between delirium and prognosis after lung cancer surgery. We retrospectively analyzed data from 570 patients who underwent surgery for primary lung cancer. Logistic regression analysis was used to determine the effects of various factors on the onset of delirium. Kaplan-Meier analysis was performed to determine the relationship between delirium and prognosis. Postoperative delirium occurred in 6.7% of the patients. Three risk factors were identified, and the risk scores were determined as follows: 2×(cerebrovascular disease history) + 1×(squamous cell carcinoma) + 1×(age older than 75 years). Scores 0-1 denoted low risk, 2 denoted intermediate risk, and 3-4 denoted high risk. Additionally, we found that patients who developed delirium had significantly shorter overall survival. However, there was no difference in the frequency between cancer-related death and non-cancer related death when comparing the delirium and non-delirium groups. We identified the risk factors, i.e., cerebrovascular disease history, squamous cell carcinoma, and age older than 75 years, that determine the onset of delirium after lung cancer surgery and constructed a useful scoring system. In addition, although the prognosis of the delirium group was poor, the factor that determines prognosis may not be cancer per se but vulnerability in the patient background.

We report a case of thymic papillo-tubular adenocarcinoma in a 55-year-old man, who had no symptoms. Sternotomy revealed a tumor in the anterior mediastinum, tightly adhered to the pericardium. It was resected completely. Interestingly, the tumor contained a unilocular cyst filled with mucinous fluid, suggesting that it originated from a pre-existing thymic cyst. Pathological examination of the tumor revealed a primary thymic papillo-tubular adenocarcinoma resembling a tumor of gut origin. Thymic adenocarcinomas, particularly of the tubular subtype, are extremely rare.

症例は乳癌・胃癌・腎癌の既往のある75歳女性．胸部CTで右肺下葉に異常陰影を認めるとのことで当科に紹介となった．胸部CTで右S8に8mm大の小結節影を認めた．retrospectiveにみると3年前の胸部CTで同部に3mm大の結節影を，2年前の胸部CTで4mm大の結節影を認めていた．増大傾向を認めており転移性肺腫瘍を疑われたため手術を行った．術中迅速組織診で腎癌肺転移と診断された．術後永久標本において豊富な淡明細胞質を有する細胞が薄壁性の類洞様血管を伴ってシート状に配列しており，免疫染色ではPAS・MelanA陽性，CD10・HMB45陰性であり淡明細胞腫と診断された．肺原発淡明細胞腫は比較的稀な腫瘍である．腎細胞癌肺転移との鑑別を要するが実際に腎細胞癌の既往を有する症例の報告は我々が検索した限り認められなかった．本症例の経過を若干の文献的考察を加えて報告する．

症例は36才男性．夕食後突然の心窩部痛を主訴に当院救急外来を受診した．腹部エコー・腹部CTでは異常を指摘されなかった．受診時体温は約38度であった．2日後症状が改善せず呼吸器科受診となった．体温は38度，血液検査上炎症所見を認め，胸部CTにて両側胸水および気管分岐部に周囲が造影される嚢胞性病変を認めた．縦隔膿瘍を疑い同日手術を行った．腫瘤は硬く，内部から白色でもろい壊死様物質を認めた．腫瘤と周囲組織とは境界不明瞭で完全摘出は不可能であり組織生検にて終了した．病理学的には大半が壊死組織であったが核異型を伴う大型リンパ球がびまん性に増殖しており，免疫染色とあわせてびまん性大細胞型B細胞リンパ腫と診断した．嚢胞状陰影を呈する悪性リンパ腫は非常にまれである．

We report a case of synovial sarcoma of the mediastinum, a very rare tumor, in a 50-year-old man hos-pitalized with anterior chest pain. Chest X-ray and computed tomography (CT) on admission showed a 10 × 8-cm mass in the right anterior mediastinal space, compressing the superior vena cava. A diagnosis of sarcoma was established by a CT-guided percutaneous needle biopsy. Systemic examination revealed no metastasis to the contralateral pleural cavity or other distant organs, and we resected the mediastinal sarcoma. Pathological and immunohistochemical analyses confirmed a diagnosis of monophasic synovial sarcoma. The patient is alive with recurrence 9 months after his operation, and is receiving chemotherapy with ifosfamide.

症例は69歳男性.2001年6月の人間ドックで胸部レントゲン上異常陰影を指摘され, 骨髄腫の疑いにて当院内科紹介となった.骨髄穿刺では形質細胞の増加は認められなかったがIgGの上昇がみられ骨髄腫と診断した.以後受診されなかったが2002年7月人間ドックで再び異常を指摘され受診てした.腫瘍の増大, IgGの上昇が認められ入院となった.MP療法 (melphalan, prednisolone), 放射線治療を行うも腫瘍の縮小を認めず, 外科的切除を行った.孤立性形質細胞腫は比較的稀な疾患であり, 本邦報告例を含め, 若干の文献的考察を加えて報告する.

pleomorphic carcinomaの1例を経験した.症例は64歳, 女性.2000年9月頃から咳噺が出現し, 胸部レントゲン写真で, 左下葉の著明な含気低下と左下葉に腫瘤陰影が認められ, 2001年1月当科紹介入院となった.胸部CT写真では, 左S6に結節陰影が認められ, 左主気管支がほぼ閉塞していた.気管支鏡検査では, 左主気管支を閉塞する白色ポリープ状の腫瘤を認めた.鉗子生検を施行したが, 正常気管支粘膜のみで確定診断は得られなかった.画像所見と内視鏡所見から肺癌を疑い, 左肺全摘除術を施行した.切除標本の肉眼的所見は, 腫瘍は左下葉から発生し, 左下葉支から左主気管支, 左上葉支までポリープ状に進展していたが, 気管支粘膜には浸潤していなかった.病理組織学的所見では, 腫瘍の大部分は腺癌であり, 腫瘍の4分の1にspindle cell, giant cellを認め, pleomorphic carcinomaと診断した.

A 69-year-old woman with refractory skin eruptions, which had first appeared 3 years previously, was examined, and an anterior mediastinal tumor was detected. The tumor was resected, and a diagnosis of type B2 thymoma, stage III disease (according to the World Health Organization classification), was made. Retrospectively, histologic findings of the skin before the operation were consistent with graft-versus-host disease. The final diagnosis of her skin lesions was thymoma-associated graft-versus-host-like disease. The skin lesions improved gradually during the 1-month period after resection with only a topical steroid, and further improvement was seen at 3 months.

症例は16歳, 男性.左側胸部痛を主訴に近医を受診し, 胸壁腫瘍と診断され紹介入院となった.左第4肋骨のほぼ全長にわたる硬化性変化が認められ, 腫瘍内部は嚢胞性あるいは壊死性変化を示した.経皮針生検を行うも, 確定診断は得られなかった.2000年4月に胸腔鏡下腫瘍生検による迅速病理で小円形細胞からなる悪性腫瘍と診断され, 第3～5肋骨合併切除術, 胸壁再建術を行った.腫瘍は8×3.8×2.2cmの大きさで第4肋骨への浸潤・破壊が著明であった.病理所見では胞体の乏しい類円形～短紡錘形の腫瘍細胞がalveolar patternを呈して増殖し, ロゼット構造も認められた.特殊染色ではMIC2遺伝子関連抗原 (CD99) が陽性であり, 胸壁に発生したPNET (いわゆるAskin腫瘍) と診断した.術後は順調に経過し, 放射線・化学療法を追加し, 現在, 術後11ヵ月が経過しているが, 再発, 転移等認めていない.

We report a case of postoperative recurrence of thymic carcinoma that was effectively treated with combination chemotherapy of nedaplatin(NDP)and docetaxel(DOC). We performed thymectomy for thymoma in a 55-year-old man. The pathological diagnosis was squamous cell thymic carcinoma(pT3N0M0, Stage III). The patient was observed without postoperative radiotherapy being administered. Six months after the operation, the patient was admitted to our department with carcinomatous pericarditis. Whole-body examination revealed multiple lung and liver metastases and a left femoral metastasis. After pericardiocentesis, radiation therapy was administered for the left femoral metastasis. Combination chemotherapy (NDP[60mg/m2]/DOC[70mg/m2])was administered for the multiple lung and liver metastases. After 4 cycles of chemotherapy, the multiple lung metastases were completely resolved and the liver metastases were clearly reduced. Partial response and acceptable toxicity were identified. Thymic carcinoma is a rare epithelial neoplasm for which the optimal chemotherapy regimen has not yet been established. Combination chemotherapy with NDP/DOC was effective in the case of our patient with postoperative thymic squamous cell carcinoma recurrence, and it can be considered as a promising regimen for patients from the standpoint of clinical efficacy.

An abnormal shadow was detected in a 75-year-old man on a chest roentgenogram, and the patient was referred to our institution. A transbronchial biopsy was carried out and the specimen resulted in a diagnosis of organizing pneumonia. During the follow-up period, the left lung lesion became enlarged. Partial resection of the left lung was performed. Postoperatively, pathological examination of the tumor showed an organizing pneumonia. Approximately 3 years later, a new calcified heterogeneous mass shadow was detected in the left lung and left pleura, which had gradually enlarged. Computed tomography (CT)-guided fine-needle biopsy of the nodule of the left pleura was performed. Microscopically, the specimen led to the diagnosis of low-grade osteosarcoma. Re-evaluation of the primary and secondary lesions were confirmed as the same histopathological findings. A further systemic examination was performed. Finally, the lesion was confirmed as low-grade osteosarcoma of the lung. The patient refused further treatment and died due to respiratory failure.

Teratomas are primary germ-cell tumours in the mediastinum. Although they are generally slow-growing and asymptomatic, rapid growth causing life-threatening complications can occur. Sebaceous secretion, insulin production, chorionic gonadotropin secretion and pancreatic enzyme secretion are the presumptive causes of tumour progression. Only few cases of rapidly growing teratomas have been reported previously. Here, we present a case of a giant mature teratoma in the mediastinum that presented with rapid growth and compare the characteristics of this case with those of previous cases.

気管腕頭動脈瘻は気管切開後のきわめて重篤な合併症である.今回,気管切開後42日目に気管腕頭動脈瘻を発症した症例を経験した.症例は62歳の男性で既往歴に結核性膿胸による右肺摘除,胸郭成形術をうけたことがあり,胸郭変形がみとめられた.外来受診時に意識消失発作から心肺停止をきたした.蘇生を行ったが低酸素脳症による意識障害が遷延し気管切開を行った.気管切開後42日目に体位変換時に気道出血がみられ,出血源を確認するために気管チューブを抜去したところ気切孔より血液の噴出がみられ,ただちに経口挿管しカフを過膨張させることにより止血した.翌日には制御不能の再出血をきたし窒息状態で死亡した.剖検により気管腕頭動脈瘻を確認した.本症例は胸郭変形により気管前壁と腕頭動脈が接しており気管腕頭動脈瘻の危険因子を有していたものと考えられた.このような症例では本症を念頭に置き発症を予防することが必要と考えられた.

A 68-year-old man was found to have tumors of the left lung and left conjunctiva. Thoracoscopic partial lung resection was performed. Histological examination revealed diffuse proliferations of centrocyte-like cells with lymphoepithelial lesions, and a diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma was made. Immunohistochemical study and flow cytometric analysis were also compatible with MALT lymphoma. Conjunctival tumor biopsy was performed and the diagnosis was confirmed. The postoperative course of the patient was uneventful, and he is currently being followed without further treatment.

Eosinophilic angiocentric fibrosis (EAF) is an uncommon inflammatory disease that develops from the respiratory organs and affects them. Almost all reports about EAF describe lesions affecting the upper respiratory tract. We present the first case of EAF of the lung treated by surgical excision. A 69-year-old female consulted our hospital following the detection of an abnormal chest shadow with chronic cough. Chest computed tomography showed a pulmonary growing mass in the right hilar area, which corresponded to an enhanced accumulation on positron emission tomography. We doubted a pulmonary malignant tumor and performed a right upper lobectomy. Pathological and other clinical presentations revealed EAF of the lung without coexisting systemic diseases. The patient had an uncomplicated postoperative course, and the presenting cough had improved. EAF can involve the lung and cause symptomatic airway obstruction. For a hilar region mass with imaging characteristics similar to those of lung cancer, a differential diagnosis must be considered.