Taiji Kuwata

S-1 Plus Cisplatin Chemotherapy with Concurrent Radiation for Thymic Basaloid Carcinoma

platin (60 mg/m 2 on day 1) and oral administration of S-1 (40 mg/m 2 , twice a day, between days 1 and 14) administered concurrently with 50 Gy of radiation. Radiotherapy was directed to all tumors including metastatic lesions. After chemoradiotherapy, two cycles of consolidation chemotherapy were performed with cisplatin and S-1. The mediastinal tumor showed a 52% reduction in size, and the right hilar lymph nodes and pulmonary nodule disappeared completely. In a FDG-positron emission tomographic scan, although the mediastinal tumor still showed a slight uptake of FDG, the other lesions showed none (Figure 1B). The patient underwent extended thymectomy with partial resection of the left lung. The resected tumor was solid, with no cystic lesions. Microscopically, there were scattered tumor cells among hyalinized collagenous fibers. Granulation tissue was also seen in the tumor, suggesting that chemoradiotherapy had induced tumor cell degeneration. The patient has survived without recurrence for 11 months since surgery, to date.

The impact of covering the bulla with an absorbable polyglycolic acid (PGA) sheet during pneumothorax surgery

We herein present the pathological findings of a bulla covered using an absorbable polyglycolic acid sheet applied with fibrin glue. These findings indicated that the membrane of the bulla was reinforced. Covering the bulla with an absorbable polyglycolic acid sheet (Neoveil, Gunze Ltd, Kyoto, Japan) and applying fibrin glue was effective to prevent the recurrence of the pneumothorax. Moreover, this report is the first case report showing the pathological findings of a bulla which was covered with an absorbable polyglycolic acid sheet and fibrin glue.

Complete Resection of Thymic Sarcomatoid Carcinoma Through Total Aortic Arch Replacement.

Sarcomatoid carcinoma of the thymus is extremely rare. An operation remains the only effective treatment for this disease. We report a case of complete resection of thymic sarcomatoid carcinoma through a total aortic arch replacement and left upper lobectomy at our institution. Our aggressive operation was very effective, and the patient has experienced no recurrence in the 3 years since his operation.

Total Vertebrectomy for Non-Small Cell Lung Cancer

We present a case who had left upper lobectomy with total vertebrectomy after arterial embolization in preparation for intraoperative bleeding. A 35-year-old man complained of left back pain. Chest CT revealed a tumor in S1+2 of the left lung, invading the third thoracic vertebra. As no nodal or distant metastasis was detected, we performed left upper lobectomy and lymph node dissection (ND2a-2) after embolization of the vessels feeding the tumor in order to reduce intraoperative bleeding. In addition, the team of orthopedics performed en bloc resection of the third thoracic vertebra and parts of the left third and fourth ribs. Histological examination of the tumor revealed pleomorphic carcinoma (pT4N0M0, stage IIIA).

Total vertebrectomy (Th2) and dissection of the subclavian artery for a superior sulcus tumor invading the spine: A case report

Highlights • The treatment of patients for lung cancer with vertebral body invasion remains challenging.• We reported a case that total vertebrectomy (Th2) and dissection subclavian artery for lung cancer invading spine and subclavian artery.• We experienced complete resected one case that tumor location and invading was very complicated.

Four Cases of Contralateral Pneumothorax After Pneumonectomy

Contralateral pneumothorax after pneumonectomy (CPAP) is a rare but potentially fatal condition. Therefore, when treating CPAP prevention of recurrence is very important. Despite a number of case reports about CPAP, its management is still controversial. We describe 4 cases of CPAP that were treated successfully by bullectomy and coverage with absorbable polyglactin mesh.

Programmed death-ligand 1 (PD-L1) expression in pleomorphic carcinoma of the lung

Pulmonary pleomorphic carcinoma (PPC) is a rare and aggressive subtype of lung cancer. Programmed cell death‐ligand 1 (PD‐L1) expression may be induced in a variety of malignant tumors, but its prognostic implication in PPC remains unclear.

Middle mediastinal thymic carcinoma with cystic findings in radiologic images: a case report

BackgroundThymic carcinomas are usually detected in the anterior mediastinum. Thymic carcinoma occurring in the middle mediastinum and showing an image of a cyst is extremely rare.Case presentationA 64-year-old man with a middle mediastinal tumor detected incidentally by a CT scan was referred. Chest CT showed an entirely cystic mass in the middle mediastinum between the bilateral brachiocephalic vein and trachea. We resected the tumor completely in the right recurrent nerve because it had invaded the nerve. Immunohistochemical features showed a thymic carcinoma pattern. The final diagnosis was thymic squamous cell carcinoma occurring in the middle mediastinum.ConclusionTo our best knowledge, this is the first report of a thymic carcinoma occurring in the middle mediastinum, as demonstrated by histopathological findings with immunohistochemical features.

Pulmonary artery reconstruction using autologous pulmonary vein for surgical treatment of locally advanced lung cancer: a case report

BackgroundResection and reconstruction of the pulmonary artery during lobectomy is a safe and effective procedure for centrally located lung cancer. We usually choose a pericardial conduit to repair a large defect of the pulmonary artery. The use of an autologous pulmonary vein conduit for reconstruction was first described in 2009.Case presentationA 64-year-old woman with left upper lung adenocarcinoma with mediastinal and hilar adenopathy was referred to our hospital. Hilar nodes had extensively infiltrated the pulmonary artery. We interposed an autologous superior pulmonary vein between the cut ends of the pulmonary artery. She was discharged without any complication on the ninth postoperative day.ConclusionsA pulmonary vein conduit is a good option for reconstruction of the pulmonary artery. We report the successful use of an autologous pulmonary vein conduit.

Total or partial vertebrectomy for lung cancer invading the spine

Background Surgery for lung cancer invading the spine remains challenging associated with high morbidity and mortality. However, recent advances in surgical techniques as well as in perioperative care may improve outcomes of lung cancer surgery with vertebrectomy. We describe our surgical approach and assess the outcome lung cancer invading the spine. Methods We retrospectively reviewed our recent experiences of lung cancer with vertebral invasion, in which we have performed total or partial vertebrectomy from January 2011 through April 2015. Results We experienced eight patients who were treated with partial or total vertebrectomy for lung cancer. Vertebral invasion was evaluated by chest CT and MRI findings. All cases were no distant metastasis. N factors were all patients N0 revealed by chest CT and PET-CT. Two patients were treated preoperative induction therapy (CDDP + TS-1, Radiation 50 Gy). For the surgery, total vertebrectomy was performed two patients, hemi vertebrectomy was two patients, transverse-process resection was four patients. In all of eight cases, complete resection were perfomed with total or partial vertebrectomy. Morbidity was observed in six patients (75%); no mortality occurred. Six patients (75%) were survived after surgery (range: 12–62 months) and four patients (50%) were no recurrence. Five years overall survival rate was 71.4%. Conclusions In our experience, Lung cancer surgery combined with vertebrectomy is highly aggressive surgery associated with high morbidity. But, this procedure is a promising treatment option for selected patients, for example N0M0 disease with lung cancer invading the spine.