Katsutoshi Adachi

Pulmonary leiomyosarcoma extending into left atrium or pulmonary trunk: complete resection with cardiopulmonary bypass☆☆☆★★★

Primary pulmonary leiomyosarcoma is a rare tumor. Few cases have been treated surgically because of its rapid invasion into the pulmonary trunk or heart and tendency toward massive intrapulmonary metastases. We report the cases of two patients with leiomyosarcoma originating in a pulmonary artery or vein that involved the pulmonary trunk or left atrium, both of whom underwent complete surgical resection with cardiopulmonary bypass (CPB). Since their operations, these patients have shown no evidence of recurrent tumor. PATIENT 1. A 72-year-old woman with persistent cough, chest pain, and hemoptysis was referred to our hospital for evaluation and treatment of presumed pulmonary thromboembolism. An angiogram revealed filling defects in the pulmonary trunk, absence of filling of the left main pulmonary artery, and decreased arterial filling in the left lung. A biopsy specimen was obtained from a tumor in the left main pulmonary artery by means of a suction catheter, and the pathologic diagnosis of sarcoma was made. Computed tomography disclosed a mass occluding the left main pulmonary artery and densely filling pulmonary artery branches. Median sternotomy was performed and CPB was applied. The left pulmonary veins were ligated and the left main pulmonary artery was incised. A large tumor completely filled the left main pulmonary artery. Extension of the incision into the pulmonary trunk disclosed that the tumor invaded its wall laterally on the left. The portion of tumor located in the left main pulmonary artery and pulmonary trunk, including the left main pulmonary artery and the left lateral wall of the trunk, was excised. Direct suture closure of the pulmonary trunk was carried out and CPB was terminated. The left main bronchus was transected and left pneumonectomy was completed. Fig. 1 shows the resected left lung and pulmonary artery. Tumor in the main pulmonary artery extended intraluminally into its branches. The tumor was diagnosed histologically with the aid of immunohistochemical stainFrom the Department of Thoracic and Cardiovascular Surgery, Mie University, School of Medicine, Tsu, Japan.

Surgical repair of extracardiac unruptured acquired valsalva aneurysms

Two cases of extracardiac unruptured Valsalva aneurysms due to rare causes are reported. One patient had been suffering from hyper eosinophilic syndrome. Operative corrections consisted of total replacement of the aortic root. The other patient had an aneurysm of just noncoronary sinus of Valsalva and a dilated ascending aorta due to cystic mucoid degeneration. Replacement of the ascending aorta with patch closure for the aneurysm was successfully performed.

Clinical Analysis of Mediastinal Tumors Associated with Lung Tumor.

教室では過去17年間に縦隔腫瘍症例を153例経験しており, うち肺腫瘍との合併症例は5例で, これらについて検討を加えた.男性2例, 女性3例, 年齢は35歳から76歳で, 診断は胸腺腫と肺癌症例2例, 縦隔嚢胞性腫瘍と肺癌症例2例, 胸腺腫と肺過誤腫症例1例であった.全例手術症例で, うち合併切除は3例であり, 70歳以上の高齢者2例は手術侵襲を少なくする目的で縦隔腫瘍は良性と判断し切除せず肺腫瘍のみ切除し, 術後, 縦隔腫瘍に変化はみられなかった.開胸方法は縦隔腫瘍と肺腫瘍のどちらの切除を重視するかで違いがあり, 胸骨正中切開法, 前側方切開第4肋間開胸法, 後側方切開第5肋骨床開胸法を施行した.この5例の検討により, 縦隔腫瘍に肺腫瘍を合併した症例では症例の背景因子, 術前診断, 腫瘍部位を考慮して手術術式を決定すべきであると考えられた.