Keigo Okamoto

Thymoma-Associated Graft-Versus-Host–Like Disease With Skin Manifestations Improved by Complete Resection of Thymoma

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.

A surgical case of eosinophilic angiocentric fibrosis of the lung.

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.

Low-Grade Osteosarcoma of the Lung Diagnosed at the Time of Recurrence

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.