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In this study, we defined a solitary lung nodle in the same histology which could be traced its' origin from carcinoma in situ or was found over than two years' follow up as a second primary lung cancer. These cases were excluded. Eighteen cases underwent second surgery for intrathoracic recurrence. Fourteen cases were male and four cases were female. Their ages ranged from 23 to 75 (average 59.6) years. The histology were adenocarcinoma in 9 cases, squamouscarcinoma in 7, adenosquamous carcinoma in 1, large cell carcinoma in 1. The initial surgical procedures were lobectomy in 17, partial resection in 1. The initial stage were I in 13, II in 2, IIIA in 1. Pulmonary recurrence were found in 10, bronchial stump recurrence were found in 4, pulmonary hilus lymph node recurrence were found in 2, mediastinal lymph node recurrence were found in 2, pulmonary stump recurrence was found in 1. The second surgical procedures were completion pneumonectomy in 7, completion lobectomy in 1, lobectomy with segmentectomy in 1, segmentectomy or partial resection in 7, mediastinal dissection in 2. The overall 5-year survival rate of the patients with recurrence after reoperation was 31.8%. An aggressive surgical approach for recurrent lung cancer should be recommended.

Ninety seven patients with metastatic lung tumors were treated surgically in our department. Second pulmonary resections were performed in 13 patients. They consists of 9 males and 4 females, their age ranged from 12 to 75 years old (average 54.4 years old). Tumors originate from sarcoma in 5 cases, laryngeal cancer, colorectal cancer, renal cell cancer in 2 cases respectively, oral cavity cancer and transitional cell cancer in 1 case respectively. No second pulmonary resection was performed in patients with metastatic lung tumors originating from lung cancer or breast cancer, because they metastatize not only lung but also general organs. No second pulmonary resection was required in patients with testicular tumor and choriocarcinoma, because chemotherapy take good effect on them.

In this study, we evaluated 15 surgically treated cases of lung cancer with scalene node metastasis. Eleven males and 4 females with ages ranging from 41 years to 78 years (average 59.1 years) were examined. Seven cases was in the right upper lobe, 3 in the left upper lobe, 2 in the right lower lobe, 2 in the left lower lobe, 1 in the middle lobe. Adenocarcinomas were found in 9 cases squamous cell carcinomas were in 4 cases and large cell carcinomas were in 2 cases. Two cases was in T 1, 7 in T 2, 2 in T 3, 4 in T 4. In all cases, lobectomy was performed. Five year survival rate was 14.3% as determined by the Kaplan-Meier method. Average survival period was 26.6 months. Three cases survived over 3 years including one case survived over 10 years.

A 46-years-old man was admitted because of an abnormal shadow on X-ray. The operation underwent under the diagnosis of benign tumor in the antero-superior mediastinum. At the operation, the tumor arise from the right intrathoracic vagal nerve and it was resected with the transection of vagal nerve. The histological diagnosis was schwannoma. Postoperative course was uneventful except the slight hoarseness. Intrathoracic vagal tumor is rare and we have found 19 reported cases among Japanese literatures. This case is considered to be the 20th case originated from the intrathoracic vagal nerve in Japan.

A 53-year-old male was admitted because of an abnormal chest roentgenogram showing a solitary tumor shadow in the right upper lung field. Laboratory data was normal. Although examination with the bronchoscope and sputum cytology showed no abnormal findings, a partial resection of the right upper lobe was performed. Microscopic examination of the lesion was cryptococcosis. As another focus was not found by systemic examination, the lesion was disclosed primary pulmonary cryptococcosis. Cryptococcosis is rare but we must think of it when we meet a solitary tumor shadow on the chest roentgenogram.