Yohei Yurugi

First experience of robotic extended thymectomy in Japan for myasthenia gravis with thymoma

We performed robot (da Vinci)-assisted thoracoscopic extended thymectomy (rThx) for myasthenia gravis with thymoma. The patient was a 66-year-old woman who complained of palpebral heaviness. Robotic operation was performed in the supine position by placing four ports in the right chest wall under 10 mmHg CO2 insufflation using three arms and one assist port. Compared with conventional video-assisted thoracic surgery (VATS), the bilateral upper horns, fat around the diaphragm, and aortopulmonary window could be resected more easily. The tumor measured 41 mm maximum diameter and was diagnosed as type AB noninvasive thymoma. The operating time was 298 min, console operating time was 203 min, and the amount of bleeding was small. The postoperative course was uneventful with no complications. This is a report of the first Japanese case of rThx for myasthenia gravis. rThx is a promising technique, and further improvement in the procedure is expected.

Case of thoracoscopic right upper lobectomy for lung cancer with tracheal bronchus and a pulmonary vein variation.

A 58‐year‐old woman visited our hospital with the chief complaint of an abnormal chest shadow. Chest CT showed an 18‐mm ground‐glass opacity in the right upper lobe, which became enlarged over time, and lung cancer was suspected. At the same time, a tracheal bronchus originating directly from the trachea was observed. She underwent thoracoscopic right upper lobectomy and mediastinal lymph node dissection. During surgery, in addition to the tracheal bronchus, a pulmonary vein variation was seen running dorsal to the pulmonary artery. Her postoperative course was uneventful. Tracheal bronchus is a rare anomaly, with an incidence of 0.1%–5%. Since tracheal bronchus is often accompanied by pulmonary vessel variations and may be associated with repeated previous infections, care should be taken when performing thoracoscopic lung resection.

Intrapulmonary schwannoma in the right middle lobe: A case report

Herein, we report a patient with a rare disease, intrapulmonary schwannoma. The patient was a 61‐year‐old woman who had a 20 mm × 18 mm nodule, with a clear boundary and homogeneous content, on the central side of S4 in the right lung on chest CT. On PET with 18‐ fluorodeoxyglucose scanning, 18‐fluorodeoxyglucose accumulations with a maximal standardized uptake value of 2.5 and 3.3 were observed in the early and late phases, respectively, suggesting a malignant tumor. A thoracoscopic right middle lobectomy was performed because the tumor was present in the segmental bronchial region of the middle lobe. Intrapulmonary schwannoma accounts for 0.2% of lung tumor cases, and cases involving patients who have undergone preoperative PET with 18‐ fluorodeoxyglucose scanning have rarely been reported.

Podoplanin expression in cancer-associated fibroblasts predicts unfavourable prognosis in patients with pathological stage IA lung adenocarcinoma.

Podoplanin expression in cancer‐associated fibroblasts (CAFs) has been proposed as an unfavourable indicator in squamous cell carcinoma of the lung, but little is known about its clinical significance in early‐stage lung adenocarcinoma. We evaluated the prognostic impact of podoplanin expression in patients with pathological stage (p‐stage) IA lung adenocarcinoma as categorised by the 8th edition of the tumour–node–metastasis classification for lung cancer.

Thymic metastasis of breast cancer 22 years after surgery: A case report

We report a rare case of thymic metastasis of breast cancer. A 68‐year‐old woman, who had undergone surgery for cancer in her right breast and had been free of recurrence for 22 years, was noted to have an abnormal shadow on a chest X‐ray at a regular medical checkup. Further workup, including chest CT, revealed a 22 × 18‐mm mass in the anterior mediastinum. Fluorine‐18‐fluorodeoxyglucose‐PET showed increased fluorine‐18‐fluorodeoxyglucose uptake that was highly suggestive of thymoma. Thoracoscopic thymothymectomy was performed. The tumor had invaded the pericardium, which was also resected. A small nodule was found in the right lung, and it was also resected. The intraoperative frozen‐section diagnosis was breast cancer metastasis to the thymus and lung. The pathological diagnosis was luminal A solid tubular carcinoma (strongly estrogen receptor and progesterone receptor positive, HER2 negative) with an MIB‐1 index of less than 5%. After surgery, the patient was treated with an aromatase inhibitor. As of August 2013, she has been free of recurrence for more than 36 months. It is extremely rare for breast cancer to metastasize to the thymus more than 20 years after surgery.