Michio Fujino

Diagnostic Usefulness of p16/CDKN2A FISH in Distinguishing Between Sarcomatoid Mesothelioma and Fibrous Pleuritis

The distinction between sarcomatoid mesothelioma and fibrous pleuritis is difficult based on histology, especially when the amount of tumor tissue examined via biopsy is small and immunohistochemical examination is inconclusive. We studied the usefulness of deletion of p16 with fluorescence in situ hybridization (FISH) and p16 hypermethylation with polymerase chain reaction for the diagnosis and prognosis of malignant pleural mesothelioma (MPM). We analyzed 50 MPMs, including 22 sarcomatoid mesothelioma cases and 10 fibrous pleuritis cases. We set the cutoff value of homozygous deletion pattern as 14.4% based on FISH signaling patterns using samples of fibrous pleuritis. The percentage of homozygous deletion pattern was higher than 14.4% in 55.6% of the epithelioid mesotheliomas (10/18) and in all of the sarcomatoid mesotheliomas (22/22). Methylation of p16 was observed in 7 (20.6%) of 34 informative cases. p16 FISH analysis can be a reliable test for distinguishing between sarcomatoid mesothelioma and fibrous pleuritis and a prognostic factor for MPM.

Rupture of the descending thoracic aorta caused by blunt chest trauma: report of a case.

A 66-year-old man fell from a tree and was diagnosed to have multiple fractured ribs and hemopneumothorax based upon the chest roentogenogram findings. He underwent chest tube drainage and evacuation using video-assisted thoracic surgery. One week after the operation, he exhibited recurrent hemothorax. He underwent a thoracotomy, and the hemothorax was found to be due to a penetration of the lower descending thoracic aorta by a fractured rib. We performed a direct closure of the penetrated portion of the descending thoracic aorta. The patient has remained well for 1 year following the second operation.

Successfully treated postbronchoplasty bronchial stenosis using short-interval repeated endobronchial balloon dilation

A 63-year-old man with a history of lung cancer underwent lobectomy of the right upper lobe and bronchoplasty. At the 2-month follow-up, bronchial stenosis due to a granuloma was observed. Endoscopic débridement and balloon dilation were performed. At 1 month after the dilation, atelectasis occurred owing to cicatricial stenosis. We repeated balloon dilation, but the patient suffered from cicatricial restenosis. After a failed stent placement, balloon dilation was then performed every 2 weeks under local anesthesia; the stenosis was resolved after performing dilation 7 times. Short-term repeated balloon dilation was effective in this case.

Pyothorax-Associated Lymphoma Diagnosed by Preoperative Pleural Effusion Aspiration Cytology: A Case Report

BACKGROUND Pyothorax-associated lymphoma (PAL) is a comparatively rare tumor, and it is difficult to definitively diagnose it preoperatively, especially in patients with only pleural thickening without mass formation. Pleural effusion aspiration cytology is a useful and easy diagnostic method for a large number of chest diseases. However, the cytologic findings of PAL have been rarely described. Here we report on the cytologic findings in a patient with PAL, manifested by pleural thickening without mass formation, and which was diagnosed preoperatively by pleural effusion aspiration cytology. CASE A 64-year-old man was admitted to our hospital because of pleural thickening involving an empyema sac located in the left thorax and rapidly increasing pleural effusion. He had a 30-year history of chronic empyema and a 10-year history of diabetes mellitus. Left pleural effusion aspiration cytology showed malignant lymphoma. The patient was admitted to our hospital for PAL treatment. Because of poor respiratory function, he only underwent decortication with complete resection of the thickening pleural peel. However, he was well, without recurrence, 5 years after the operation. The histologic examination revealed that lymphoma cells were located only in the thickening pleural peel. CONCLUSION This is a very rare case of PAL diagnosed by preoperative aspiration cytology for an increasing pleural effusion. This report demonstrates that pleural effusion aspiration cytology can be valuable for the diagnosis of PAL.