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Abstract Purpose  The relative rarity of malignant pleural mesothelioma (MPM) in Japan makes it difficult to perform a large-scale clinicopathological study of this tumor at a single institute. Thus, we performed a multiinstitutional study to evaluate the current status of diagnosis and treatment in Japan. Methods  We analyzed the records of 65 patients with MPM, obtained from the 13 institutions comprising the Japanese Chiba Multicenter Study Group. Results  In 56 patients, the tumor was detected after a visit to a medical facility for subjective symptoms such as chest pain, shortness of breath, and cough. It took a median period of 2 months from the initial visit to establish the diagnosis. The overall survival rates of 33 patients with unresectable MPM 1, 2, and 3 years after the diagnosis were 40.5%, 10.8%, and 0%, respectively, whereas those of 32 patients who underwent surgery were 67.9%, 35.0% and 10.9%, respectively (P = 0.0035). According to multivariate analysis, histological type, International Mesothelioma Interest Group clinical stage, sex, and the presenting symptom of shortness of breath were significant prognostic factors. Conclusions  The definitive diagnosis of early MPM is difficult, but establishing the best diagnostic modality would improve survival rates, since radical surgery is likely to be effective for resectable disease. [ABSTRACT FROM AUTHOR]

In following up a patient with non-Hodgkin's lymphoma, we encountered a case of pulmonary pleomorphic carcinoma with mediastinal direct invasion. A 65-year-old man with hemoptysis was found to have an abnormal shadow in the right upper lung field. A 6.4 × 4.8-cm tumor adjacent to the upper mediastinum occupied the right anterior segment of the upper lobe (S3) and invaded the superior vena cava (SVC). The serum level of neuron-specific enolase was elevated to 11.9ng/ml. A specimen from a transbronchial lung biopsy of the right B3b bronchus revealed giant tumor cells. A right upper lobectomy with SVC reconstruction was performed. The resected tumor was diagnosed as a pulmonary pleomorphic carcinoma with a large component of giant and spindle cells, and it is considered to be a rare histologic type. [ABSTRACT FROM AUTHOR]

Abstract A 69-year-old woman was admitted with dyspnea on effort and left lung atelectasis on chest X-ray. Fiberoptic bronchoscopy revealed a complete obstruction of the left main bronchus due to a polypoid lesion. This lesion was diagnosed to be a schwannoma arising from the left lower bronchus. Bronchoscopic treatments were performed with electrosurgical snaring and the intratumoral injection of 99.5% ethanol. These treatments were performed once per week for 4 weeks, then were followed with a one-time application of semiconductor laser cautery. These treatments opened the airway and restored the left lung expansion. However, a residual tumor remained at the bifurcation of the left basal bronchus and B6. A cautious follow-up was conducted because schwannoma is a potentially benign tumor. A follow-up bronchoscopic examination at 21 months revealed a regrowth of the residual tumor. A complete resection using a left S6 sleeve segmentectomy was thus performed. The pathologic diagnosis of the tumor was benign schwannoma. There were no complications and no evidence of disease recurrence has been observed after the surgery. [ABSTRACT FROM AUTHOR]

Abstract Neurogenic benign tumors arising from the trachea and bronchus are relatively rare. We experienced three cases of neurofibroma of the bronchus which were successfully treated by transbronchial electrical snaring and Nd-YAG laser abrasion. The first was a 67-year-old man with right lung cancer, who was pointed out to have a neurofibroma in the left main bronchus. The second was a 34-year-old man with an obstruction in the right main bronchus due to neurofibroma. The third was a 66-year-old woman with a complete obstruction in the left main bronchus due to schwannoma. All patients were successfully treated to remove the tumors and obtain a patency of the bronchus by transbronchial electrical snaring and Nd-YAG laser abrasion. We also review 23 reported cases of endobronchial neurogenic tumors and discuss the efficacy of endoscopic treatments for endobronchial neurogenic tumors. [ABSTRACT FROM AUTHOR]

A 67-year-old man was admitted to our hospital because of an abnormal chest echoic lesion detected incidentally by echocardiography. A chest roentgenogram showed the presence of a giant mass, and computed tomography of the chest confirmed the presence of a mass with a nonhomogeneous density in the left mediastinum, just adjacent to the left ventricle of the heart. Percutaneous aspiration cytology of the mass showed benign fibrous cells and a small amount of lymphocytes. The preoperative diagnosis of the tumor suggested a thymoma, and the patient underwent a thoracotomy. A pedunculated tumor arose from the visceral pleura of the left upper lobe of the lung, and it was capsulated within the pleura. The tumor measured 15 Ö 12 Ö 8?cm in size and it was successfully resected. The pathological diagnosis of the tumor was benign localized fibrous tumor of the pleura. [ABSTRACT FROM AUTHOR]

Abstract  A solitary metastatic tumor from thyroid papillary carcinoma is rarely diagnosed preoperatively. A 61-year-old woman was referred to us for investigation of a solitary nodule in the right lung field on a chest X-ray, several years after a right hemithyroidectomy for thyroid carcinoma. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of a tumor in the right lower lobe, adjacent to the inferior pulmonary vein, revealed metastasis of thyroid papillary carcinoma. Immunohistochemical examination of histological cores obtained from the EBUS-TBNA proved extremely helpful in confirming the diagnosis. We performed right lower lobectomy with lymph node sampling, and the final pathological diagnosis was papillary carcinoma without lymph node metastasis. [ABSTRACT FROM AUTHOR]

We herein report a resection of a superior sulcus tumor in a patient with idiopathic thrombocytopenic purpura. A resection of the left upper lobe of the lung, left subclavian artery, and left first to third ribs, as well as a reconstruction of the left subclavian artery, were performed. Postoperative hemorrhaging was controlled due to preoperative high-dose intravenous immunoglobulin therapy and a platelet transfusion both during and following surgery. The resected tumor was diagnosed to be a pulmonary pleomorphic carcinoma, which was pathologically determined to be T3N0M0-Stage 2B. The patient remained in good condition for 20 months following the surgery; however, he eventually died due to bone metastases. [ABSTRACT FROM AUTHOR]

Abstract We report a case of lymphangioleiomyomatosis (LAM) with a giant bulla. A 33-year-old woman was referred to our department for treatment of dyspnea. Chest computed tomography showed a giant bulla with many smaller bullae. To obtain a definitive diagnosis and relieve the dyspnea, we performed a lung biopsy and bullectomy, after which her symptoms and pulmonary function improved remarkably. She was commenced on progesterone, which improved her condition even further. This case report retrospectively follows the progression of her disease from the onset of symptoms 5 years before she was referred to us for treatment. [ABSTRACT FROM AUTHOR]

A 66-year-old man fell from a tree and was diagnosed to have multiple fractured ribs and hemopneumothorax based upon the chest roentogenogram findings. He underwent chest tube drainage and evacuation using video-assisted thoracic surgery. One week after the operation, he exhibited recurrent hemothorax. He underwent a thoracotomy, and the hemothorax was found to be due to a penetration of the lower descending thoracic aorta by a fractured rib. We performed a direct closure of the penetrated portion of the descending thoracic aorta. The patient has remained well for 1 year following the second operation. [ABSTRACT FROM AUTHOR]

We report the case of a 60-year-old woman referred to us after chest X-ray and mobile computed tomography screening detected an 8-mm nodule in right S2. Transbronchial aspiration cytology suggested a pulmonary metastasis from colorectal cancer. Therefore, we performed a colonoscopy and found a polypoid lesion, 2?cm in diameter, in the sigmoid colon. An analysis of a biopsy specimen from this polypoid lesion confirmed adenocarcinoma. Surgical resection of the primary sigmoid colon cancer was subsequently performed, followed 4 weeks later by a right S2 segmentectomy to remove the lung metastasis. The patient is currently well without any clinical signs of recurrence, 44 months after her operation. [ABSTRACT FROM AUTHOR]