Keigo Takagi

Successful resection of a glomus tumor arising from the lower trachea: Report of a case

Tracheal glomus tumors are extremely rare. We present herein the case of a 43-year-old man with hoarseness who was found to have a glomus tumor arising from the lower trachea. Bronchoscopy and chest computed tomography revealed a polypoid mass in the membranous portion of the trachea just above the carina. The patient underwent successful tracheal sleeve resection and reconstruction. A pathologic diagnosis of a glomus tumor with clear surgical margins was subsequently confirmed, and the patient is well 20 months postoperatively with an intact anastomosis.

A comparison of biopsy through a parasternal anterior mediastinotomy under local anesthesia and percutaneous needle biopsy for malignant anterior mediastinal tumors

The various methods of treating the numerous types of anterior mediastinal neoplasms are undergoing refinements; however, prior to the commencement of any treatment, an accurate histologic diagnosis must be established. We conducted a retrospective analysis of biopsies performed through a parasternal anterior mediastinotomy (PAM) on 21 patients with an anterior mediastial mass suspected of being malignant by computed tomography (CT) and other clinical information. Patients with possible localized thymomas were excluded. Mediastinotomy, which enables relatively large tissue samples to be taken, was performed through the bed of the second or third costal cartilage under local anesthesia. In 19 of the 21 patients (90%), the histologic diagnosis made from the mediastinotomy biopsy was identical to the final diagnosis. Conversely, although the tissue obtained from needle biopsy was sufficient for a histologic diagnosis in 11 of 12 patients, the histologic diagnosis made from the needle biopsy was the same as the final diagnosis in only 5 of 10 patients (50%). Thus, diagnostic accuracy was significantly higher in the mediastinotomy biopsies than in the needle biopsies (P=0.0318). Moreover, the mediastinotomy biopsy specimens revealed subtypes of lymphomas and germ cell tumors. All of the patients from whom a mediastinotomy biopsy had been taken began appropriate therapy without delay according to the histologic diagnosis. These results suggest that the PAM approach should be chosen as the preferred method of biopsy for suspected malignant anterior mediastinal tumors.

Empyema and mediastinitis complicating retropharyngeal abscess.

A 21 year old man with a retropharyngeal abscess complained of right sided chest pain, and chest radiography and thoracocentesis revealed an empyema. A computed tomographic scan of the chest showed a posterior mediastinal abscess communicating with the right pleural cavity. Emergency thoracotomy was performed and the mediastinal abscess and empyema were drained.

Periosteal Chondroma Developing in a Rib at the Side of a Chest Wall Wound from a Previous Thoracotomy: Report of a Case

We describe herein the case of a 45-year-old man who developed a periosteal chondroma in a rib at the site of a thoracotomy that had been performed 24 years previously. To our knowledge, this is only the third case of a periosteal chondroma in a rib to be documented in the world literature. Some authors have suggested that trauma, including that of surgery, may induce chondroma formation and this association could have been an important contributing factor in the induction of the tumor in this patient.

Thoracoscopic resection of a solitary pulmonary lymphangioma: report of a case

We present herein the rare case of a young man who was found to have a solitary tumor in the right upper lobe of his lung by a routine chest X-ray. The tumor was removed by thoracoscopic surgery, and pathological examinations confirmed the diagnosis of a primary lymphangioma of the lung. A brief review of the available literature on this extremely rare type of benign tumor follows the case report.

Immunohistochemical Analysis of Cathepsin B Expression in Human Lung Adenocarcinoma: The Role in Cancer Progression

Production of cathepsin B by tumor cells has been linked to metastatic potential in several experimental models. Sections of 95 primary lung adcnocarcinomas were examined for expression of cathepsin B using a standard avidin‐biotin immunohistochemical technique. Staining for cathepsin B was observed in 22.1% of all cases and 28.0% of those of the Clara cell type. In Clara cell adenocarcinomas, cathepsin B expression correlated with positive lymph node status, presence of distant metastases, and poor prognosis (P<0.05). However, no correlation with clinical outcome was observed in other cell types. Our data suggest that cathepsin B may be involved in invasion and metastasis in Clara cell lung adenocarcinoma.

Mesenchymal chondrosarcoma of the rib: Report of a case

Mesenchymal chondrosarcoma is a rare malignant cartilaginous tumor arising within the bone or soft tissue. An 18-year-old woman presented with a tumor on her left fourth rib. We performed a wide resection of the tumor and administered three cycles of postoperative adjuvant chemotherapy. Three years after the operation, the patient is alive without any evidence of either local recurrence or distant metastases. The findings of this case may thus support the usefulness of a radical resection and adjuvant chemotherapy for mesenchymal chondrosarcoma.

Gene rearrangement studies on lymphoma of the lung: Report of a case

We describe herein how true lymphoma of the lung was differentiated from pseudolymphoma in a 45-year-old woman presenting with pulmonary infiltrates. Although segmental resection revealed typical histologic findings of pseudolymphoma of the lung and immunohistochemical studies did not demonstrate a monoclonal proliferation, Southern blot analysis of the frozen tissue revealed rearrangements in the heavy and light chains of the immunoglobulin gene, with no T-cell receptor gene rearrangement suggestive of a lymphoproliferative disorder. These findings indicate that the identification of gene rearrangement may be utilized to distinguish between true lymphoma and pseudolymphoma.

Thoracoscopic CO laser coagulation shrinkage of blebs in treatment of spontaneous pneumothorax

Spontaneous pneumothorax is a common disease in young people. Operative intervention has been done in most of the recurrent cases. Recently thoracoscopic treatment has been tested as a less invasive treatment modarity. We adopted carbon monoxide (CO) laser for thoracoscopic treatment of recurrent spontaneous pneumothorax. CO laser (wavelength; 5.4 micrometers ) could be delivered by chalcogenide glass (As - S) covered with a teflon sheath and ZnSe fiber tip. The sterilized flexible bronchoscope was inserted through the thoracoscopic outer sheath under local anesthesia. Shrinkage of blebs was obtained by non-contact method of CO laser irradiation. Laser power at the tip was 2.5 - 5 W and irradiation duration was 0.5 s each. Excellent shrinkage of bleb and bulla could be obtained by CO laser without perforation complication. Advantages of CO laser as a thoracoscopic treatment were: (1) capability of fiber delivery (flexible thoracoscopy was easy to operate and clear to visualize the blebs which were frequently found at the apical portion of the lung, and (2) shallow extinction length (good shrinkage of blebs, low risk of perforation, and thin layer of carbonization). In conclusion, our new technique of thoracoscopic CO laser irradiation was found to be a safe and effective treatment of spontaneous pneumothorax.