Search

A 28-year-old male presented to our hospital with hemoptysis and his chest computerized tomography (CT) showed the right middle and lower lobe atelectasis due to the tumor of right intermediate bronchial trunk. To reduce the blood flow to the tumor, bronchial arterial embolization was performed and the tumor was resected using Cryoprobe with a flexible endobronchial scope. Thus, we could observe the tumor localization and diagnose before the surgical procedure. We performed the right sleeve middle lobectomy and the right lower lobe was safely preserved.

A 35-year-old man had chronic cough and was treated as asthma at local doctor. Since the symptoms was not improved, chest computed tomography( CT) was performed and an approximately 5 mm nodule with calcification was found in the left main bronchi. He was referred to our hospital for treatment. Bronchoscopic examination revealed a polypoid lesion in the membranous part of the left main bronchus. Since transbronchial biopsy revealed no malignant findings, bronchoscopic resection using microwave tissue coagulation and electrosurgical snaring was performed safely under the general anesthesia. The tumor was histologically diagnosed as endobronchial hamartoma.

Pulmonary hamartomas are common benign lung tumors. Most cases are parenchymal chondromatous hamartomas, whereas endobronchial lipomatous hamartomas are rarely encountered. A 78-year-old man was referred for left superior subsegmental atelectasis due to obstruction by an endobronchial tumor that was found incidentally on chest computed tomography for the postoperative follow-up of colon cancer. Bronchoscopy showed a polypoid tumor in the orifice of the left upper segmental bronchus. Lipoma was diagnosed by a bronchoscopic biopsy. We performed a segmentectomy of the upper division of the left lung because the tumor was presumed to be located peripherally to the left B3 segmental bronchus. A histopathological examination revealed that the tumor was an endobronchial lipomatous hamartoma that extended to the pulmonary parenchyma beyond the bronchial wall.

A 69-year-old woman was referred to our hospital due to an abnormal shadow on a chest roentgenogram. Computed tomographic scanning revealed a complete atelectasis of the left lower lobe. Though the definitive diagnosis was not obtained preoperatively, we performed a left lower lobe excision because atelectasis existed for more than one year. Immunohistochemical staining showed that tumor cells were positive for vimentin, CD34, bcl-2, CD99, and negative for S-100, α-smooth muscle actin. The tumor was diagnosed as a solitary fibrous tumor of the bronchus, which has been rarely reported to date.

A 68-years-old male patient had been diagnosed as having bronchial carcinoid in B2 and right upper lobectomy with systematic hiler and mediastinal lymphadenectomy had been performed in 1996. Pathological diagnosis was a typical carcinoid (pT1aN0M0, stage I A). In 2004, 4 tumors were found in the trachea, right bronchial stump, right main bronchi and right B6 orfice. These were diagnosed as typical carcinoids by pathology. In 2005 argon plasma coagration was performed.In 2013, a localized recurrence was found in the right S6 by chest computed tomography (CT). The segmentectomy of the right S6 was performed. Even after radical operation for typical carcinoids, we should conduct long-term observation.

A 47-year-old woman was treated at a local hospital for obstructive pneumonia in February 2011. A computed tomography(CT)scan revealed a nodule obstructing the right upper bronchus. Histological diagnosis could not be established by biopsy under the bronchoscopic examination. She was referred to our hospital for further treatment. Since accumulation of fluoro-2-deoxy-D-glucose(FDG)was noted by positron emission tomography(PET)[standardized uptake value(SUV)max 5.67/7.52], primary lung cancer was suspected and right upper sleeve lobectomy was performed. Pathology during surgery suggested the tumor to be schwannoma. Postoperative course was uneventful.

Tumors of the tracheobronchus consist of tracheobronchial gland tumor, squamous cell carcinoma, and other tumors. Tracheobronchial gland tumors, such as adenoid cystic carcinoma or mucoepidermoid carcinoma, are rare tumors, and resemble salivary gland tumors pathologically. Surgical complete resection should be considered if possible. Radiotherapy alone results in less survival compared to complete resection. Radiotherapy or palliative bronchoscopic recanalization is a choice of therapy when unresectable. Over all survival rate after operation has been reported to be 66-79% at 5-year and 51-57% at 10-year. Mortality of the surgery is less than 5% in Japan. Adjuvant radiotherapy is often adopted when surgical margin is pathologically positive, since adenoid cystic carcinoma is thought to be radiosensitive tumor.

Unlabelled: We performed bronchoplasty for a bronchogenic tumor of low-grade malignancy without lung parenchyma resection. A 69-year-old man visited our hospital in March 2008 because of cough. Chest computed tomography (CT) revealed atelectasis of the entire left upper lobe and a 2-cm mass with strong contrast enhancement in the lumen of the left main bronchus. Bronchoscopy identified a polypoid mass in the left main bronchus, about 3 cm distal to carina, obstructing the lumen. Biopsy led to a diagnosis of typical carcinoid tumor. Surgery : Thoracotomy showed complete atelectasis of the left upper lobe. After lymph node dissection, resection of the left main bronchus including the site of tumor origin was performed. From the extent of expansion, the left upper lobe was decided to be possible to be spared, and end-to-end anastomosis of the bronchus was performed. Postoperative respiratory rehabilitation resulted in improved aeration of the left upper lobe and markedly improved respiratory function., Conclusion: The judgment of whether the long-standing atelectatic left upper lobe could be spared or not was a key in choosing this procedure.

A 19-year-old man visited our hospital with a diagnosis of carcinoid arising from the right intermediate bronchus. Clinical examination revealed T3N1M0 lung cancer, so right pneumonectomy with mediastinal lymph node dissection was performed after obtaining informed consent from the patient and his parents. Final pathological diagnosis was T2N2M0 typical carcinoid. Typical bronchial carcinoid with lymph node metastasis is very rare in patients under 20 years old.

Photodynamic therapy (PDT), neodymium yttrium aluminum garnet (Nd-YAG) laser therapy, electrocautery and microwave coagulation therapy are therapeutic options available for management of endobronchial malignancies. All of these treatment modalities have been used for both palliation of late obstructing cancers, and more recently have been used as primary treatment of early stage lung cancers. Only PDT has the curative potential for patients with early superficial squamous cell carcinoma. Nd-YAG laser therapy is used for direct thermal ablation of tissue in endobronchial malignancy. This equipment is the most widely used type of laser for bronchoscopic interventions because it has sufficient power to vaporize tissues and produces an excellent coagulation effect. But the risks of perforation and bleeding are high. Endobronchial electrocautery is the use of high-frequency electrical current that generates heat due to tissue resistance, resulting in destruction of tissue. Argon plasma coagulation (APC) is a form of noncontact electrocoagulation. The risks of perforation and igniting are much lower than with the Nd-YAG laser therapy. Microwave coagulation therapy refers to the use of all electromagnetic methods for inducing tumor destruction by using devices with frequencies of 2450 MHz. It is important to select these treatment methods appropriately according to each case.

A 13-year-old girl was referred to our hospital for chest pain and atelectasis of left upper lobe on chest X-ray film. Bronchoscopy revealed an endobronchial tumor obstructing left main bronchus. Left upper lobectomy with bronchoplasty was performed. The tumor was a polyp 34 x 17 x 17 mm in size and obstructed left main bronchus. Histologically the tumor was a low-grade malignant mucoepidermoid carcinoma with malignant pleural effusin. The patient has been well and free of recurrence for 8 years postoperatively.

A 52-year-old man was admitted to our hospital because of an abnormal shadow on chest X-ray. Chest computed tomography scan and broncho-fiberscopic examination revealed a tumor at the left main bronchus. The tumor was removed completely by partial resection of the left main bronchus with thoracotomy. Historical finding of the resected specimen revealed a benign pleomorphic adenoma of the bronchus. The postoperative course was un-eventful for 9 years. We reported a rare case of pleomorphic adenoma of the bronchus.

18-year-old male was referred to our hospital due to persistent cough. The patient was admitted for the investigation of the abnormal shadow on a chest X-ray and chest computed tomography (CT). Chest CT showed a 2.5 cm nodular shadow in the right lower lobe. Bronchofiberscopy revealed the polypoid lesion at the right lower lobe bronchus obstructing the entire lumen of B8-10. The tumor surface was smooth and rich in small vessels. Right lower lobectomy was peformed. The diagnosis of schwannoma was confirmd with the S-100 positive immunohistochemical stain. Bronchial schwannoma is relatively rare disease; less than 90 cases have been reported with respect to schwannoma of case report in Japan.

A 63-year-old female presented with an abnormal shadow on a chest X-ray. A serial chest computed tomography (CT) showed ground-glass attenuation, which measured 2 cm on S1+2 of the left lung. When bronchofiberscopy was performed to make a diagnosis, a tumor with a smooth surface was revealed which obstructed the right middle bronchus. Leiomyoma was thus diagnosed. At first, a wide wedge resection of left lung tumor was performed. Secondly, a bronchus tumor was successively removed using a high frequency snare and a laser by a bronchofiberscopy. Her postoperative course was uneventful. Leiomyoma of the bronchus is rare benign tumor. This report describes the performance of a resection using bronchofiberscopy with good results.

Benign endobronchial tumors are rare, and among these endobronchial neurinoma is extremely rare. We describe a case of endobronchial neurinoma successfully treated with left lower lobectomy. A 58-year-old man presented with an 8-month history of cough. During this period he was repeatedly treated with antibiotics for pneumonia of the left lower lobe. Chest X-ray showed atelectasis of the left lower lobe. Computed tomography (CT) of the chest showed a mass in the left main and lower lobe bronchi. Bronchoscopy revealed the mass almost completely obstructing the left main bronchus. Although transbronchial biopsy was inconclusive and yielded necrotic tissue with Aspergillus hyphae, lung cancer was highly suspected based on clinical and radiographic findings. He underwent left lower lobectomy and was discharged 14 days after surgery in good condition. Pathological diagnosis was an endobronchial neurinoma 4 cm in size arising from the left basal bronchus. On immunohistochemical staining, the tumor was positive for S-100 protein and negative for a-smooth muscle actin. He took itraconazole at a daily dose of 200 mg orally for 6 months. He remains well 52 months after surgery without any evidence of recurrence.

A 17-year-old man in whom mucoepidermoid carcinoma of the left upper lobe bronchus was successfully treated by bronchoplasty. The patient has been suffered from relapsing respiratory infections over the past 2 years. Bronchoscopic examination revealed a tumor at the orifice of the left upper lobe bronchus. Thus, left upper sleeve lobectomy was carried out. The tumor was 18 x 15 x 14 mm in size and obstructed left upper bronchus with mucoid impaction peripherally. Hystological examination confirmed a diagnosis of low grade malignant mucoepidermoid carcinoma without lymph node metastasis. The patient has been well and free from recurrence for 4 years postoperatively.

We report a case of bronchial lipoma, which relapsed after endoscopic treatment, and was treated by surgical resection. An abnormal shadow on chest X-ray was noted at the annual medical checkup of a 44-year-old man. Chest computed tomography (CT) demonstrated a tumor in the right basal bronchus and linear opacity on the peripheral side of that tumor. Bronchoscopic examination demonstrated a smooth polipoid tumor occluding the right basal lobe bronchus. Bronchoscopic biopsy specimens were not sufficient for histological diagnosis. We performed endobronchial resection of the tumor using electrosurgical snare, but 2 months after endoscopic treatment, the tumor relapsed. We therefore performed right S(9+10) segmentectomy. The tumor was 11 x 9mm in size and the histological diagnosis was an endobronchial lipoma. More than 4 years after resection, the patient is alive without recurrence.

A 63-year-old man who was pointed out abnormal shadow on chest X-ray admitted to our hospital. Chest computed tomography (CT) showed a tumor originated from right upper bronchus and grew into right main bronchus. The tumor was diagnosed as mucoepidermoid carcinoma by bronchoscopic biopsy. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed abnormal uptake localized at the tumor. The standardized uptake values of the tumor 60 minutes after injection were 2.86, and 120 minutes after injection, it increased to 3.97. Right upper lobectomy with bronchoplasty by deep wedge resection of right main bronchus at the orifice of right upper bronchus and lymphadenectomy was performed. Pathological diagnosis was high-grade mucoepidermoid carcinoma without lymph nodes metastasis which was compatible with FDG-PET. Postoperative course was uneventful.

A 6-year-old boy was admitted to our hospital with a history of recurrent obstructive pneumonia and hemoptysis. A chest computed tomography (CT) showed atelectasis in the left lower lobe. Angiograpy, which was performed for the suspicion of pulmonary sequestration, showed no feeding artery and revealed bleeding from the bronchial artery in the left lower lobe. As hemoptysis would not stop, an emergency left lower lobectomy was performed. Macroscopic examination of the resected specimen revealed a mass measuring 20 x 15 x 17 mm in the S8 proximal lung parenchyma, bronchiectasis, and an abscess in the distal lung parenchyma. Histopathologic examination determined the tumor was a mucoepidermoid carcinoma. Immunohistochemical staining revealed some tumor cells were positive for CA 19-9. The child has not had a recurrence 3 years postoperatively.

We report a case of synchronous tumors consisted of bronchial carcinoid and adenocarcinoma of the lung. A 58-year-old female was referred to our hospital after screening, because an abnormal shadow was noted in the right lung on her computed tomography (CT) of the chest. CT scans showed a peripheral pulmonary mass in the right middle lobe and a nodule around the right lower lobe bronchus. The nodular lesion like swollen lymph node was diagnosed as bronchial carcinoid originated in B6 by bronchoscopy. The pulmonary mass was diagnosed as adenocarcinoma by using core needle biopsy during operation. Right middle and lower bilobectomy and mediastinal lymph node dissection were performed. Coincidence of a bronchial carcinoid and an adenocarcinoma of the same side of the lung is a rare occurrence.

A 71-year-old man was admitted to our hospital with a small protrusive lesion at the lingular orifice of the left upper bronchus. He had undergone a right lower lobectomy and mediastinal dissection for lung carcinoma (large cell carcinoma, pT1N0M0) 14 months earlier. Early hilar squamous cell carcinoma was diagnosed by chest radiograph, CT and transbronchial biopsy. We performed a lingular segmentectomy with wedge resection of the left upper bronchus and N 1 lymph node dissection. The tumor was histopathologically diagnosed as early hilar second primary lung carcinoma. The patient's postoperative course was uncomplicated. At present, he is alive with good respiratory condition and without any evidence of recurrence. Segmentectomy is appropriate for a patient with contralateral second primary lung carcinoma as well as a patient with early hilar lung carcinoma. Bronchoplasty seems to increase the likelihood that such a patient will be a candidate for segmentectomy.

For the treatment of central type lung cancers, it is often necessary to perform bronchoplasty or bi-lobectomy even in early stage cases in which tumor invasion is found at the bronchial bifurcation. To solve this contradictory situation, we applied PDT for central type early stage lung cancer to reduce the extent of superficial infiltration, enabling a simple surgical technique or decreasing the amount of resected lung parenchyma. Among 7 patients, the simplification of surgical technique and reduction of the range of resection were possible in 2 cases each respectively. However, these objectives were not satisfied in the remaining 3 cases and the operations performed were those that had been originally scheduled before PDT. The current problems are the establishment of appropriate laser irradiation technique and accurate assessment for extension of invasion.

19 surgically treated cases with bronchopulmonary carcinoid in our hospital were studied clinically, and we discussed the criteria of limited operation for typical carcinoid. 11 cases had typical carcinoid and 8 had atypical. All patients of typical type were alive with no recurrence. No lymph node metastasis was revealed in all cases of typical type. On the contrary, in cases of atypical type, 1 had n 2 disease and 1 had distant metastasis. The five survival rates of patients with typical carcinoid was 100%, and significantly better than that of patients with atypical, 27%. Therefore, patients with typical carcinoid can be cured by limited operation, but radical operation should be indicated for atypical carcinoid.

A 55-year-old woman, who had treated as bronchial asthma for eight months, was admitted to our hospital. Chest CT scan showed a mass in the left main bronchus. Bronchoscopic examination revealed a tumor obstructing the left main bronchus and invading the left lower portion of the trachea. The pathologic diagnosis was adenoid cystic carcinoma. Primary resection of the left main bronchus and the carina with the objective and one-stoma-type carinal reconstruction were performed by the left thoracotomy. We pulled down the aortic arch to obtain an operative field, and carried out the operative procedure at the upper side of the aortic arch. As the resection margin contained residual tumor, the postoperative irradiation (50 Gy) was added.

We reported one case of a 26-year-old woman in whom mucoepidermoid carcinoma of the right middle lobe bronchus was successfully treated by bronchoplasty. The patient complaining fever and cough was admitted to our hospital and the bronchoscopic examination revealed a tumor mass occluding the right middle lobe bronchus. Thus, sleeve middle lobectomy was performed. The histological examination of the resected material revealed a low-grade malignant mucoepidermoid carcinoma with no lymphatic metastasis. The patient has been well and free of recurrence for one year postoperatively. In this case, sleeve lobectomy is approved of an effective method for local curability and preservation of respiratory function.

Twelve patients who suffered from low grade malignant tumors arisen in the trachea and the bronchus (6 of carcinoid, 4 of mucoepidermoid carcinoma, and 2 of adenoid cystic carcinoma) underwent surgical treatment from 1977 to 1996 in our department. Operations included 1 sleeve resection of the trachea, 1 patch plasty of the trachea, 3 sleeve lobectomies, and 7 lobectomies. Lymph node dissection was performed in 9 of 12 cases. Metastases in lymph nodes were not found in all 12 cases. Five year survival rate of low grade malignant tumors arisen in the trachea and the bronchus was 78.8% and better than that of stage I lung cancers.

Mucoepidermoid carcinoma of the lung presenting in childhood is extremely uncommon. A 7-year-old girl was referred to our hospital with complaint of persistent cough and abnormal shadow on the chest roentgenogram. Bronchoscopic biopsy revealed a bronchial mucoepidermoid carcinoma and a left pneumonectomy was performed. The histopathological examination revealed intermediate grade malignancy without any metastasis in mediastinal lymph nodes. She is now doing well without any evidence of recurrence 2 years after the operation.

A 62-year-old woman who was pointed out abnormal shadow at left middle lung field in chest X-ray was followed up as a hamartoma from 1989. In this period, the tumor was growing up in chest X-ray and occupying the left segmental bronchus (B3) in bronchofiberscopic study. It was suspected neurilemmoma by the final biopsy examination. Left upper lobectomy was performed and pathohistological diagnosis was typical neurilemmoma that consist of Antoni type A and Antoni type B. Intrapulmonary or intrabronchial neurilemmoma is rare and only 20 cases have been reported in the Japanese literature.

A 49-year-old female complaining of dyspnea at exercise was admitted. Bronchoscopic examination revealed that the left main bronchus was almost obstructed by a tumor. A sleeve resection of the left main bronchus was performed. Histological examination confirmed that the tumor was squamous papilloma. After one year and eight months, bronchofiber examination disclosed papilloma in the trachea. Therefore, papilloma was treated with endoscopic methods, including Nd-YAG laser. The patient has survived for 11 years since first treatment.

From 1973 to 1990, 7 patients presented with a adenoid cystic carcinoma of tracheobronchial tree that was treated surgically. The locations were larger airways; 4 in the trachea, 1 in the carina, 2 in the basal bronchus. Surgical treatments were performed in all cases. The following resections were done: trachea only 3; carina 1; trachea plus larynx 1; left lower lobe (sleeve lobectomy) 1; left lung (pneumonectomy) 1. Except for tracheolaryngectomy and left pneumonectomy, all cases were undergone primary anastomosis. Operative death was only one patient who died of anastomotic separation. Irradiation was performed in 6 patients before or after operation. Two patients were died due to lung metastases or leukemia. According to the Kaplan-Meier's method, the 5 years survival rate of all patients was 68.6%. Our experience suggests that surgical treatment and adjunctive radiotherapy is beneficial in patients with adenoid cystic carcinoma.

A 62-year-old male was admitted to our hospital to investigate his obstructive pneumonia-like symptoms. A chest roentgenography, computed tomography revealed the tumor to be located in the left lower bronchus. Bronchoscopy showed endobronchial tumor at the level of the left lower lobe bronchus. Preoperative pathological confirmation was possible by transbronchial biopsy, pathological diagnosis of the tumor was endobronchial chondroid hamartoma. And then, bronchoplasty was performed. He was discharged from our hospital after operation, showing no evidence.

Neodymium-yttrium-aluminum-garnet (Nd-YAG) laser was clinically introduced to the treatment of tracheobronchial lesions 10 years ago. Since then, the apparatus of the laser therapy and the flexible bronchoscopy have been improved, and the indication for its treatment has been established. Nd-YAG laser is useful at the field of the treatment of the tracheobronchial stenotic or obstructed lesions. But various complications occur, because of the lesions occupying in the narrow tracheo and bronchial lumen. In our institute, 83 cases have been treated in 196 sessions (from one to fifteen sessions per patient) for the past ten years. The stenotic or obstructed lesions were divided into three etiologies, 64 cases with malignant lesion, 8 cases with post operative granulation at the suture line and 11 cases with benign lesion. All procedures were performed under local anesthesia by using flexible bronchoscope. Among them, complications were noticed in eleven cases. They involved hemorrhage (6 cases) and respiratory disturbances (2 cases) during operative period, and massive hemorrhage (2 cases) and edema of the tumor (1 case) in the adjacent period of laser treatments.

Leiomyoma of the trachea and bronchus is a rare tumor. Only 45 cases have been reported in the Japanese literature. We report here a case of leiomyoma of the intermediate bronchus which was successfully operated on. A 45-year-old man suffered from a repeated episode of pneumonia in the right lower lobe. Bronchoscopy revealed a polypoid mass on the intermediate bronchus. The diagnosis of leiomyoma was made by bronchoscopic biopsy. Sleeve resection of the intermediate bronchus including the tumor and end-to-end anastomosis was performed. His postoperative course was uneventful and bronchoscopic findings showed clear healing of the anastomotic site. The resected specimen contained a tumor with smooth surface having protrusion into the bronchial lumen with 6 x 5 x 4 mm in size. The final pathological diagnosis was leiomyoma of the intermediate bronchus with no evidence of malignancy.

A rare case of solitary bronchial papilloma was reported. A 57-year-old male was admitted to our hospital because of an abnormal shadow on chest X-ray film which was discovered on regular health check up. Bronchoscopic examination revealed a polypoid tumor which obstructed the left B4 bronchus. Serum concentration of CEA was elevated up to 14 ng/ml by Z-GEL method. Left upper lobectomy was performed. On macroscopic examination of the excised specimen, the tumor arose in B4 bronchus and was yellowish white in color and was cauliflower-like in shape sized 3.5 X 1.5 cm. Histopathologically, the tumor consisted of papillary proliferation of stratified squamous epithelium with ciliated columnar epithelial covering. Findings suggestive of inflammation or malignancy were not observed.

Right wedge pneumonectomy was performed on two cases of primary lung cancer involved into carina. A 59-year-old male involved with primary lung cancer was found with bloody sputum. Preoperative data confirmed as the superficial spread type of squamous cell carcinoma in carinal lesion and tumor was resectable with wedge pneumonectomy. In the second case, abnormal shadow was pointed out on chest X-ray film of a 61-year-old male patient. Preoperative examination defined as primary lung cancer of rt-S6 with subcarinal lymph node metastasis. The operation indicated wedge pneumonectomy with patch plasty using the wall of right main bronchus. Although wedge pneumonectomy is not common compared to sleeve pneumonectomy, if available this procedure is technically easier and post-operative management may be more successful. Wedge pneumonectomy limits resectable area, because the continuation of tracheo-bronchial wall must be remained in part. Therefore, the indication of this procedure for surgical treatment of lung cancer is limited. However, when this procedure indicates to selected case with limited lesion of carina, this may be an useful procedure as surgical treatment of primary lung cancer.

To August, 1988, we performed tracheobronchial reconstruction for 159 patients with malignant tumors. Operative methods in these patients and the operative results studied in the end of March, 1989, was reported. As for adenoid cystic carcinoma, we stressed, by illustrating cases, that postoperative radiation therapy was useful and that it should be given for all patients with this disease. About one half of patients with thyroid carcinoma infiltrating the trachea died of symptoms related with tracheal stenosis. However, tracheobronchial reconstruction improved 10 year survival rate in patients with advanced thyroid carcinoma remarkably, which became close to that in patients with non-infiltrating thyroid carcinoma. As for lung cancer, tracheobronchial reconstruction had good indication for squamous cell carcinoma.