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We report a rare case of synovial sarcoma in the anterior mediastinum. A 43-year-old man consulted our hospital with a complaint of dyspnea and chest discomfort. Chest computed tomography revealed an anterior mediastinal mass. Small open biopsy was performed, and the pathological examination revealed spindle-shaped cells with severe atypia. Tumor resection was performed. On pathology, fascicular and storiform patterns of spindle-shaped cells with severe atypia were noted. The tumor cells were positive for cytokeratin 7, vimentin, Bcl -2 and CD99, and the amplification of SYT-SSX fusion gene was also found. Therefore it was diagnosed as a synovial sarcoma.

A 47-years-old woman (case 1) was admitted to our hospital because of a mediastinal mass. We performed an operation by VATS under the diagnosis of a mediastinal neurinoma. The histology of it was a neurinoma. Her father (case 2) had undergone a resection of a mediastinal neurinoma at the age of 42. Her brother (case 3) also had undergone a resection of mediastinal and intrathoracic neurinomas at the age of 37. A few years later, he underwent operations for neurinomas in limbs 2 times. We suppose patients with a mediastinal neurinoma have little complaints in many cases, so there are a number of patients who have a mediastinal neurinoma without being discovered and treated. Although the neurinoma is not considered as a hereditary disease inherently, the cases, we experienced, might have some genetic disorders. In this concern, our cases are very rare and have a great interest.

This is a report of the occurrence of familial ectopic pheochromocytoma in two brothers, whose father had bilateral adrenal pheochromocytoma. Both brother complained of hypertension. In the first case, a 22-year-old man presented with much higher than normal norepinephrine. Abdominal CT and chest CT scanning and 123I-MIBG scintigraphy revealed an extraadrenal tumor in the chest on the bilateral adrenal grands. Bilateral adrenectomy was performed. In the second case, the 20-year-old brother was found to have an abdominal mass that was diagnosed as ectopic pheochromocytoma originating in the intra-abdominal paraaorta according to abdominal CT scanning and 131I-MIBG scintigraphy. The tumor was resected.

Of 140 cases of mediastinal neoplasms in our hospital, histological diagnosis was confirmed in 129 cases. We examined the methods of preoperative biopsy with those 129 cases. Biopsy had been performed in 25 cases. Mediastinoscopy was performed in seven cases, needle biopsy in eight cases, lymph node biopsy in eight cases, esophageal biopsy using a gastrofiberscope in one case, transbronchial biopsy using a bronchoscope in one case. The true positive rates of those methods were 100% for both mediastinoscopy and lymph node biopsy, and 75% for needle biopsy. Preoperative misdiagnosis occurred in two cases of needle biopsy. The postoperative histological diagnosis was malignant lymphoma in both cases. We performed gene analysis of the immunoglobulin heavy chain gene, light chain kappa and lambda genes, and the T-cell receptor beta gene by use of biopsied specimens, and we found rearrangement bands of these genes in the cases of malignant lymphoma. Therefore, we summarize that gene analysis is a reliable method if malignant lymphoma is suspected. If a needle biopsy is performed under CT guidance, the needle is sure to puncture the tumor. We concluded, therefore, that if a tumor is located in the anterior mediastinum, CT-guided needle biopsy should be performed first of all. Mediastinoscopy is a useful method if the tumor is located in the mid-mediastinum.

We experienced an operation of a 16-year-old female of mediastinal vagal neurinoma. Abnormal shadow was pointed out on chest X-ray at physical examination of high school. Right thoracotomy was performed under the diagnosis of mediastinal tumor. There was a walnut sized mass on the right vagal nerve at just peripheral side of the recurrent nerve branch. The vagal nerve was cut at both sides of the mass not to injure the recurrent nerve. The tumor was removed en block. Two little finger sized masses were recognized in serratus anterior muscle and 5 th. intercostal nerve. These removed masses were diagnosed as neurinoma pathologically. While the mother of this case had been admitted on another hospital because of multiple neurinomatosis with bilateral acoustic neurinoma. Thus this case is of familial neurinomatosis, suggesting it's heredity like as neurofibromatosis (von Recklinghausen's disease).