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A 45-year-old woman was referred to our hospital because of a tumorous shadow in the S10 segment of the left lung. A chest computed tomography (CT) scan showed a nodular lesion with a slightly irregular margin and no contrast enhancement. CT-guided aspiration biopsy was tried but did not result in a histological diagnosis. The tumor was excised during video-assisted thoracoscopic surgery. Histological examination of the specimen revealed cavernous hemangioma. Most cells lining the lumen of the cavernous structure stained positively for von Willebrand factor antibody and negatively for anti-epithelial membrane antigen antibody, which suggests that the tumor was associated with endothelium. To the best of our knowledge, this is the first report of a case in which the diagnosis of pulmonary cavernous hemangioma was confirmed with an immunohistological study.

A 53-year-old woman with a smoking history of 20 pack-years was admitted to the hospital because of dry coughing and exertional dyspnea that had progressed over the previous 3 months. A chest X-ray film taken one month before the onset of symptoms was almost normal. Diffuse small nodular shadows with infiltration were evident one month after the onset of symptoms, and increased rapidly until admission to the hospital. Eosinophilic granuloma was diagnosed histologically after thoracoscopy. The symptoms, chest X-ray findings and pulmonary-function data improved spontaneously after admission to the hospital and the nodular shadows had a almost completely disappeared by 5 months later; the patient continued to smoke. The present case is unique and valuable because it shows the natural course of eosinophilic granuloma from the onset of symptoms to remission.

We report one operated case (a 71-year-old female) of intralobar pulmonary sequestration (Pryce's type 1) associated with an accessory diaphragm. The patient had hemoptysis for 5 years. Lateral chest X-ray showed an oblique line attaching to the central portion of the right diaphragm. Selective angiography and ultrasonography showed an aberrant vessel originating from the abdominal aorta. At the time of operation, the pleural cavity was divided into two compartments by a fibrous membrane. The bronchus of the lower compartment and the pulmonary veins ran through a hole in the accessory diaphragm. The aberrant artery flowed into the parts of lung in the upper and lower compartments.

A 69-year-old woman was hospitalized because of abnormal lung shadow and IgG-lambda paraproteinemia. She was otherwise healthy and asymptomatic. Chest roentgenogram showed a consolidation in the right lower lobe. Chest CT showed a tumour in S8 and subpleural interstitial shadow in S10. No intrathoracic lymphadenopathy was found. Serum IgG was 6,109 mg/dl. The cell count obtained by bronchoalveolar lavage (BAL) was 44.5% plasma cells and 17.5% lymphocytes. CD19-positive lymphocytes were prominent. The IgG/albumin ratio was 13 times higher, and IL-6/albumin ratio was 29 times higher in lavage fluid than in serum. Transbronchial lung biopsy (TBLB) specimen showed interstitial infiltration of plasma cells and lymphocytes. Right lower lobectomy was performed, and serum IgG subsequently decreased to about 4,000 mg/dl. DNA was extracted from the surgical specimen, and analyzed by Polymerase Chain Reaction (PCR) method. A rearrangement band was amplified with Fr3a & VLJH primers (immunoglobulin heavy chain gene). The infiltrated cells were proved to be monoclonal B-cells. This case was diagnosed as small lymphocytic lymphoma, plasmacytoid. Most primary pulmonary lymphomas are well differentiated B-cell type, and the histopathological findings resemble those of LIP or pseudolymphoma. Gene analysis may thus be an effective procedure for the distinction between inflammatory and neoplastic cell proliferation, such as LIP and lymphoma.

A 33-year-old male was admitted to our hospital because of an abnormal shadow in the right superior mediastinum on chest X-ray, which was first noted about half a year before his admission. Several diagnostic procedures, including fiber bronchoscopy, CT scan and MRI; however, no final diagnosis could be made. Thoracotomy was performed with the presumed diagnosis of benign mediastinal cystic tumor. Entry of the right thoracic duct into the cyst was observed at operation. Histological examination revealed that the cyst was lined by mono-layered cuboidal epithelial cells with lymphocytic infiltration in the wall of the cyst. The mono-layered cuboidal epithelium of the thoracic duct gradually changed to the epithelium of the cyst. Twenty ml of colorless transparent fluid was aspirated from the cyst. Analysis of aspirated fluid revealed low concentration of several substances except LDH compared to the values of the previously reported normal standards and other reported cases. From these findings, the cyst was diagnosed as mediastinal lymphatic cyst. Entry of the thoracic lymphatic duct into the mediastinal lymphatic cyst is a rare occurrence, and it is of interest to speculate on its relationship to the origin of the lymphatic cyst.

Three cases of dumbbell neurogenic tumor of the posterior mediastinum are reported. None of these cases had any clinical symptoms, and an abnormal mass shadow of the mediastinum had been detected on routine chest roentgenogram. In these three cases, however, myelogram and/or CT findings were suggestive of tumor extension to the spinal canal in various degrees. Two tumors were resected in two-stage operations with combined thoracic and neurosurgical approaches, and the other case was treated by one-stage operation with the combined two approaches. All tumors were completely resectable without serious complications such as hemorrhage, leakage of spinal fluid, or neurologic deficit. Even in asymptomatic patients with neurogenic tumor located in the paravertebral region, it should be determined whether or not the tumor extends to the spinal canal through the intervertebral foramen, prior to planning the surgical procedure.

We reported two operated cases (a 35-year-old male and 52-year-old male) of mediastinal goiter accompanied by marked tracheal deviation. The two patients did not have any clinical symptoms. CT, MRI, ultrasonography and angiography finding of the two cases are presented. Fluid was obtained from the cystic lesions by ultrasonically guided needle aspiration. The levels of thyroid hormones (T3, T4) in the fluid were not high in comparison with serum levels. Surgical resection was performed on the 35-year-old male case by collar incision and on the 52-year-old male case by median sternotomy.