Hironori Ishibashi

Resection of endobronchial hamartoma by bronchoplasty and transbronchial endoscopic surgery

Endobronchial hamartoma is a rare, benign tumor usually associated with pneumonitis and atelectasis caused by obstruction. Lobectomy is sometimes performed even if the tumor is benign. Transbronchial endoscopic surgery is usually performed for patients with a small endobronchial hamartoma. We report our treatment of a large hamartoma completely obstructing the patients left main bronchus. The tumor was partially resected, and that remaining was resected by transbronchial endoscopic surgery. No finding of recurrence of the endobronchial hamartoma was detected by endoscopy or biopsy for 3 years. A combination of bronchoplasty and transbronchial endoscopic surgery benefits patients with large endobronchial hamartoma by preserving the lung parenchyma.

Modified central venous catheter for pneumothorax

Pneumothorax frequently requires drainage, and many thoracic surgeons continue to use the traditional rigid chest tubes. Traditional tube thoracostomy using a large-bore tube is an essential technique for thoracic surgeons, but it is associated with significant pain at the time of insertion and during continued drainage. We have found a new small-bore, flexible thoracostomy method using a modified central venous catheter that is simple, less painful, and safe.

Multiple Thymoma with Myasthenia Gravis: Report of a Case

Abstract.A resected case of multiple thymoma is reported. The patient was a 47-year-old man with myasthenia gravis of Ossermann IIB type. Multiple thymomas were detected on a chest computed tomography scan and an extended thymothymectomy was performed. There were two separate thymomas in the anterior mediastinum: one measuring 60 × 60 mm and another measuring 25 × 25 mm in diameter, and both tumors pathologically consisted of predominantly lymphocytic forms.

Successful excision of a giant mediastinal vagal schwannoma causing severe tracheal stenosis through a median sternotomy.

Vagal nerve schwannomas that compress the trachea are extremely rare. We report a case in which a giant middle mediastinal schwannoma accompanied by severe tracheal stenosis was excised. A 70-year-old woman had a 30-year history of hoarseness and paralysis of the left recurrent laryngeal nerve. She presented with chronic cough and dyspnea, which she had experienced for several months. Computed tomography indicated a middle mediastinal mass (8.3×7.1×4.9 cm) that directly compressed the lower trachea, carina, both bronchi, and the left main pulmonary artery. The trachea was 4 mm in diameter at the narrowest point. Through a median sternotomy, the superior vena cava, ascending aorta, right pulmonary artery, and trachea were dissected, and the tumor was excised by gentle dissection. Histologic examination indicated a benign schwannoma.

Endobronchial Granular Tumor Excision With Bronchial Resection Inclusive of Second Carinoplasty

Bronchial granular cell tumor is a rare tumor. A 39-year-old nonsmoking woman was admitted to our hospital with back pain. Chest computed tomography scan and bronchoscopy revealed a 10-mm endobronchial tumor arising from the membrane near the second carina. The tumor was excised inclusive of the right second carina that contained the extraluminally invaded endobronchial mass and was diagnosed as a granular cell tumor. The postoperative course was uneventful, and the patient was well without signs of recurrence for 3 years of follow-up.

High expression of P-cadherin is significantly associated with poor prognosis in patients with non-small-cell lung cancer

OBJECTIVES Placental (P)-cadherin expression is associated with malignant phenotype of cancer cell. The loss of E-cadherin has been thought to play a key role in tumor progression in several cancers. In this study, we aimed to clarify the role of P-cadherin expression in non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS NSCLC patients (n = 172) were enrolled in this study; among them, 107 harbored adenocarcinomas, and 65 had squamous cell carcinomas. We examined P-cadherin and E-cadherin expression by immunohistochemical analysis and assessed the associations between each cadherin expression and both cadherin expression patterns with clinicopathological factors and prognosis. To investigate the pathway to acquire tumor progression associated with P-cadherin and E-cadherin, we examined p120 catenin localization by immunohistochemical analysis. RESULTS High P-cadherin expression was significantly associated with lymphatic metastasis, pathological stage, and Ki-67 proliferation index (P < .05, respectively). Low E-cadherin expression was significantly associated with maximum standardized uptake value, lymphatic metastasis, and pathological stage (P < .05, respectively). The cytoplasmic p120 catenin localization was associated with the low E-cadherin and high P-cadherin expression group (P < .001). High P-cadherin expression was associated with shorter disease-free survival (P = .044) and shorter overall survival (OS; P = .044). The low E-cadherin and high P-cadherin expression group was associated with shorter OS (P = .024). CONCLUSIONS High P-cadherin expression was associated with tumor progression and poor patient survival in NSCLC. In these patients, the low E-cadherin expression might be associated with tumor progression involving cytoplasmic p120 catenin.

Excision of thoracic vertebral chondrosarcoma after spinal decompression

A 44-year-old man presented with an abnormal chest shadow. Computed tomography-guided biopsy showed a chondral tumor of the thoracic vertebrae. Five years later, he developed a walking disorder, left leg numbness, and a vesicorectal disorder. Emergency orthopedic spinal decompression was performed. Eight months later, the residual tumor had become larger and was adjacent to the aorta. Prior to thoracotomy, an intraaortic stent was inserted. The 4th and 5th ribs were invaded by the tumor. The entire tumor and chest wall were excised with the aortic adventitia. The tumor was diagnosed as a low-grade chondrosarcoma of the thoracic vertebrae.

Preservation of the lung after 4-year compression by fibrous tumors of pleura

Solitary fibrous tumor of the pleura is a neoplasm arising from mesenchymal tissue, which may cause dyspnea and cough. Computed tomography in a 72-year-old woman, who had been diagnosed with a 3-cm mass in the left upper lung 24 years previously, identified 15- and 10-cm tumors, with complete collapse of the lingula and lower lobe. The tumors were successfully excised with partial lung resection, and the collapsed lung was preserved. There was no recurrence or atelectasis at 4 years postoperatively.

Successful excision of a massive bleeding schwannoma by thoracoscopic surgery.

Massive intrathoracic bleeding caused by rupture of a benign schwannoma is extremely rare. A 73-year-old man was admitted to our emergency department because of chest pain and dyspnea. Computed tomography revealed massive pleural effusion and a posterior mediastinal tumor. Chest tube thoracostomy was performed, and the initial blood drainage was 1700 mL. Magnetic resonance imaging revealed that the tumor at the 8th costal level measured 46 × 60 mm. The tumor, located beside the 8th vertebra, had ruptured and caused the bleeding. It was successfully excised by thoracoscopic surgery and diagnosed as a benign schwannoma.