Takahiro Omori

Thoracoscopic lung biopsy in 285 patients with diffuse pulmonary disease

Background Surgical lung biopsy is generally considered the most appropriate method for diagnosing diffuse lung disease. However, there are few reports focusing on only one thoracoscopic technique. This study was designed to determine the morbidity and mortality related to video-assisted thoracoscopic lung biopsy in a single center, thereby providing data on the severity of morbidity and clarifying the risk factors. Methods We analyzed 285 patients with undiagnosed diffuse lung disease who underwent video-assisted thoracoscopic lung biopsy at Kanagawa Cardiovascular and Respiratory Center from February 2007 to April 2012. We recorded the severity of postoperative complications using the Clavien-Dindo classification. Results The surgical morbidity was 7.0% (20/285), including delayed pulmonary fistulas in 11 patients, acute exacerbation in 3, prolonged air leakage (>7 days) in 2, hypoxemia in 2, atrial fibrillation in 1, and premature ventricular contraction in 1. Based on the Clavien-Dindo classification, grade I, II, IIIa, IIIb, and IVa complications accounted for 20%, 10%, 50%, 5%, and 15%, respectively. The 30-day mortality was 0%. The diagnostic yield was 100%. Although acute exacerbation occurred in 2 patients with idiopathic pulmonary fibrosis and 1 with fibrotic nonspecific interstitial pneumonia, there were no distinctive features that allowed preoperative prediction of acute exacerbation. Conclusions Our findings indicate that video-assisted thoracoscopic lung biopsy is a feasible procedure. We hope to clarify risk factors in future research.

A case of epithelial-myoepithelial carcinoma of the bronchus - a review of reported cases and a comparison with other salivary gland-type carcinomas of the bronchus.

We present a case of a polypoid tumor located in the right middle lobe bronchus. The tumor was composed of bi-layered glandular or ductular structures consisting of inner cuboidal cells and outer multipolar cells. Immunohistochemical examinations confirmed epithelial and myoepithelial differentiation in the inner and outer components, respectively. Consequently, the tumor was diagnosed as an epithelial-myoepithelial carcinoma. Epithelial-myoepithelial carcinomas of the bronchus are very rare neoplasms with low-grade malignant potential. To date, including our case, only 27 cases have been reported in the English literature. Here, we review the reported cases and compare them with other salivary gland-type carcinomas regarding clinical, biological, and genetic features.

The pathological features of idiopathic interstitial pneumonia-associated pulmonary adenocarcinomas.

To investigate the pathological features of idiopathic interstitial pneumonia (IIP)‐associated pulmonary adenocarcinoma.

Inflammatory malignant fibrous histiocytoma of thymus origin.

A 46-year-old man was referred to our department complaining of anterior chest pain. A chest computed tomographic scan revealed an anterior mediastinal tumor measuring 38 x 35 x 50 mm. Suspecting a thymoma, we performed extended thymectomy through a median sternotomy under general anesthesia. Pathologically, the tumor was composed of pleomorphic spindle-shaped cells arranged in a storiform pattern, with marked inflammatory cell infiltration. The tumor was contiguous with the thymus tissue. Based on these findings, we made the diagnosis of inflammatory malignant fibrous histiocytoma originating from the thymus. Until now, 12 months later, the patient has shown no evidence of tumor recurrence.