Hiroyuki Oura

Dendriform pulmonary ossification: unusual cause of spontaneous pneumothorax

A 53-year-old man was admitted to our hospital with a recurrence of spontaneous pneumothorax. He had no history of other diseases including chronic lung diseases. A month prior to this admission, he had a first pneumothorax and was treated with 4u2005days of intercostal drainage. CT scan showed no bulla, but revealed multiple small polygonal lesions consistent with fibrotic lesions mainly in the right lower lobe (figure 1). We performed right thoracotomy and found that air leakage arose from torn visceral pleura which had been pierced by a drumstick-shaped bony structure (figure 2A). Some other solid flat lesions were palpable in the …

Non-circumferential tracheal resection with muscle flap reconstruction for adenoid cystic carcinoma

Circumferential airway resection with primary anastomosis has been widely adopted as a treatment for adenoid cystic carcinoma (ACC) of the trachea. However, carinal resection is a complicated procedure with high mortality and morbidity rates. We describe a technique of non-circumferential tracheal resection performed to treat ACC arising from the lower membranous trachea adjacent to the carina. The tumor was resected while preserving the tracheo-carinal cartilage. A silicone Y-stent was placed at the bifurcation to ensure airway patency before closing the defect. The airway defect, measuring 4xa0×xa02.5xa0cm, was closed using an autologous pericardial patch and pedicled latissimus dorsi muscle flap. These procedures were technically easy, and no postoperative airway complication occurred.

Pulmonary hypertension confirmed histologically five months prior to scleroderma renal crisis onset

A 69-year-old man presented shortness of breath and acute renal failure. He had undergone pulmonary partial resection for lung cancer 5xa0months prior. On examination, severe hypertension, skin sclerosis of his forearms, and anticentromere antibody were observed. A renal biopsy specimen showed characteristic findings for scleroderma renal crisis, and a right heart catheterization revealed severe pulmonary arterial hypertension. Re-examination of the resected lung specimen revealed sclerodermatous vascular involvement was present.

A Case of Intraosseous Well-differentiated Osteosarcoma of the Rib With Long-term Survival

背景. 骨内分化型骨肉腫は, 長期の臨床経過をたどる低悪性度骨腫瘍として最近知られるようになった骨肉腫の1亜型である. その肋骨原発は非常に稀であり, 今回報告する. 症例. 45歳男性, 38歳時 (昭和63年) より胸部X線写真上, 右胸壁の異常影を指摘されていた. 平成7年4月近医を再受診した際, 腫瘤影の増大が認められ, 同年6月当科紹介となった. 胸部X線写真上では, 右胸壁より上肺野に突出する4cm大の辺縁整の腫瘤影を認めた. 胸部CTでは右第4肋骨に内部不均一な腫瘍を認めた. 悪性骨腫瘍の可能性を考慮し同年7月18日手術を施行, 右第4肋骨の部分切除および上下肋間筋の合併切除を施行した. 術後の病理組織検査にて右第4肋骨原発の骨内分化型骨肉腫と診断された.術後は化学療法や放射線療法を施行しなかったが, 約7年経過した現在, 再発なく生存中である. 結論. 骨内分化型骨肉腫の組織診断は困難であるが, 本例では組織学的に骨周囲組織への浸潤像がfibrous dysplasiaとの重要な鑑別点となった. さらに, 腫瘍を完全切除できたことが, 初回発見時より14年という長期生存に寄与したものと考えられた.