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The Japan Society for Pneumothorax and Cystic Lung Disease conducted a nationwide retrospective survey to identify correlations between the timing of surgical intervention and the incidence of transfusion, and to examine the factors contributing to the need for transfusion among clinical features in surgically treated spontaneous hemopneumothorax (SHP) patients.We analyzed the characteristics and perioperative results of patients with SHP who underwent thoracoscopy or thoracotomy between April 2009 and March 2019.From 17 institutions, 171 cases were enrolled in this study. Receiver-operating characteristic curve analyses for the incidence of transfusion and waiting time before the operation revealed an area under the curve of 0.54 (95% confidence interval [CI] 0.44-0.64). Therefore, we did not compare the clinical features using a cutoff value of waiting time before the operation. More than 80% of the patients underwent surgical treatment within 24 h from admission. Multivariate analysis revealed that the total volume of hemorrhage was the only significant factor contributing to the incidence of transfusion (p = 0.00011, odds ratio: 0.03, 95% CI 0.0051-0.18). Moreover, multivariate analyses revealed that the waiting time before the operation was a contributing factor for prolonged total hospitalization (p 0.0001, estimated regression coefficient: 0.036, 95% CI 0.027-0.045).In SHP patients, a reduction in the waiting time before the operation significantly contributed to not the avoidance of transfusion but a reduction in total hospitalization time. In addition, transfusion was performed depending on the volume of blood loss.

Background Granulosa cell tumors (GCTs) are uncommon sex cord-stromal ovarian neoplasms. We report a case of GCT presenting in the chest, 18 years after oophorectomy for ovarian cystadenocarcinoma. Case presentation A 63-year-old female was admitted to our hospital for evaluation of a right hilar lesion. Subsequent abdominal and pelvic computed tomography and brain magnetic resonance imaging were unremarkable. Eighteen years earlier, the patient had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy at another institution for a uterine myoma, with the pathological findings indicating a uterine myoma, dermoid cyst of the right ovary, and serous cystadenocarcinoma and endometrioid adenoacanthofibroma around hemorrhagic cyst of the left ovary. No indication of a granulosa cell tumor (GCT) was present in either ovary. As such, diagnostic video-assisted thoracoscopic surgery was performed, revealing a well encapsulated tumor located next to the inferior pulmonary vein and small, disseminated lesions on the chest wall and diaphragm. Thereafter, we performed resection of the main tumor in its entirety and the disseminated lesions to the extent possible. Pathological examination of the resected specimens revealed a neoplasm characterized by sheets and islands of closely packed tumor cells exhibiting small follicles (Call-Exner bodies) surrounded by cells with pale, uniform nuclei, typically observed in the microfollicular pattern of adult GCT. Although the etiology of occurrence of intrathoracic granulosa cell tumor is unknown, we assumed that the neoplasm oriented from radiologically undetectable peritoneal seeding at the time of her previous surgery, with subsequent migration through the diaphragm. Over the next 10 years, she received chemotherapy with cyclophosphamide, adriamycin, and cisplatin; other combination chemotherapy; single-agent chemotherapy; and palliative radiotherapy. She died from malignant pleuritis and peritonitis 10 years after thoracoscopic surgery. Conclusions We have reported a case of a 63-year-old female with a history of ovarian cystadenocarcinoma who underwent resection of a pleural neoplasm, which turned out to be a granulosa cell tumor. This possibility resulted from dissemination of a previous abdominal lesion.

OBJECTIVES Radiologically invasive non-small-cell lung cancer, defined as consolidation size to maximum tumour diameter ratio of over 0.5, is associated with pathological invasiveness and worse prognosis. However, there are no real-world, nationwide database studies on limited resections that consider radiological invasiveness. This study aimed to investigate the prognostic validity of limited resection, such as segmentectomy and wedge resection, in cStage IA (TNM 8th edition) radiologically invasive lung cancer. METHODS We conducted a retrospective analysis of patients who underwent complete resection according to the Japanese Joint Committee of Lung Cancer Registry Database. The relationship between surgical procedures and prognosis was examined using stratification by cT factor and radiological invasiveness. RESULTS Among the 5,692 patients enrolled, lobectomy, segmentectomy and wedge resection were performed in 4,323 (80.0%), 657 (11.5%) and 712 (12.5%) patients, respectively. Multivariable analysis with or without propensity score matching indicated that older age, poor performance status and wedge resection were significantly associated with worse prognosis and that patients who underwent segmentectomy showed an equivalent prognosis to those who underwent lobectomy. Subset analyses revealed that segmentectomy showed an equivalent prognosis to lobectomy in patients with cT1b or less, but not in those with cT1c, especially for non-pure radiological invasive cT1c; 5-year overall survival rates were 91.4% vs 90.4% in cT1b with non-pure radiological invasiveness and 80.0% vs 83.8% in cT1b with pure radiological invasiveness, respectively. CONCLUSIONS Segmentectomy can be an alternative to lobectomy in patients with radiologically invasive lung cancer with cT1b or less but not in those with cT1c.

A 40-year-old woman with lymphangiomatosis also had an intrathoracic lymphangioma infection. Since the age of 8 years, the patient had undergone repeated abdominal and mediastinal cyst surgeries and had received a diagnosis of lymphangiomatosis. At this time, she showed a high fever of 38.5°C. Cultures of both blood and fluid aspirated from the cyst were positive for Staphylococcus aureus. Chest CT imaging revealed an enlarged right-sided mediastinal cystic lymphangioma with new septa in it. A chest tube was inserted into the cyst to remove effusion. The patient was then started with the antibacterial drug cefazolin at 3 g/d. But effective drainage was difficult because of the high viscosity of the effusion and septa working as barriers. We removed these components with endoscopic surgical instruments and via a pulsed-lavage system under general anesthesia. Postoperative CT images showed reexpanded lung structure and reduced cyst size. The patient has taken a favorable course for 2 years.

We aimed to investigate if Computed tomography (CT) attenuation values can help improve the identification of age-related changes in the thymus. We assessed CT images of 405 patients aged 0 to 80 years. We measured the area of the anterior mediastinum at the level of the carina and its average CT attenuation value. We evaluated the thymic area, the ratio of the thymus area to the total thoracic area, and the CT attenuation value. Additionally, we evaluated changes in the thymus area in the 0 to 13-year age group. The area of the thymus decreased from birth to the middle 20s. After the middle 20s, the area tended to increase and plateau till after 50 years of age. The ratio of the thymic area to the thoracic area decreased from age 0 to 20 years, but remained stable after 20 years of age. The CT attenuation values were stable from birth to puberty, decreased after puberty, and were stable again in the late 50s and beyond. The thymus of children showed mass formation, but the shape changed with age. No significant differences in the CT attenuation value were found across underlying conditions for the 0 to 13-year age group. The decrease in the CT attenuation values, observed with advancing age, reflects adipose degeneration of the thymus, indicating that by the late 50s, thymic tissue is replaced completely by adipose tissue. Our data suggest that adipose degeneration of the thymus begins after puberty and advances with age.

To investigate the association of preoperative renal dysfunction and long-term outcomes following lung cancer surgery.Using the Japanese Lung Cancer Registry data, we retrospectively examined 16,377 patients who underwent surgery for non-small cell lung cancer during 2010. Patients' renal function status was categorized as follows: serum creatinine1.5 mg/dL (control, n = 16,169), serum creatinine ≥1.5 mg/dL with no dialysis (nondialysis-dependent chronic kidney disease, n = 113), and dialysis-dependent end-stage renal disease (n = 95). The association of patients' characteristics with overall survival was evaluated using multivariate Cox proportional hazard model.The 5-year overall survival rates in patients with dialysis-dependent end-stage renal disease and with nondialysis-dependent chronic kidney disease were significantly worse than that in the control group (52.9% and 57.5% vs 78.0%; P .001 for both comparisons), but were comparable to the reported 5-year overall survival rates in the natural history of end-stage renal disease (∼60%) and moderate to severe chronic kidney disease (∼50%). Cancer causes not related to lung cancer accounted for 62.2% of deaths in dialysis-dependent end-stage renal disease, which was more frequent than that in the control group (P = .002). Dialysis-dependent end-stage renal disease and nondialysis-dependent chronic kidney disease were independent risk factors for overall survival after lung cancer surgery (hazard ratio, 2.05 [P .001] and hazard ratio, 2.04 [P = .001], respectively).Preoperative renal dysfunction may be adversely associated with overall survival after lung cancer surgery. Our findings could aid patients to set proper expectation of the risks and benefits about surgery for lung cancer.

Background Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare lung disease that manifests as parenchymal fibrosis of the upper lung lobe and pleura. There have been no reports of IPPFE complicating pregnancy. Here, we report a case of IPPFE that deteriorated rapidly during pregnancy. Case presentation A 29-year-old woman presented with dyspnea and dry cough at 19 weeks of gestation. IPPFE with acute exacerbation was suspected on chest computed tomography (CT). Despite steroid treatment, her condition progressed. A cesarean section was performed at 28 weeks of gestation. On postoperative day 26, she underwent living-donor lung transplantation. She was discharged a year after transplantation. Conclusion Our experience suggested that when pregnancy is complicated by PPFE, the disease may deteriorate rapidly. In this case, even though IPPFE with acute exacerbation was diagnosed during pregnancy, live birth was achieved, and the mother survived after lung transplantation. Lung transplantation should be considered in these patients because, once advanced, pulmonary lesions may be irreversible.

Purpose: We performed a retrospective analysis to evaluate the usefulness of positron-emission tomography/computed tomography (PET/CT) findings in the classification and management of anterior mediastinal tumors. Methods: Between 2006 and 2015, 105 patients with anterior mediastinal tumor received PET/CT. 18F-fluorodeoxyglucose (18F-FDG)-PET images were obtained 60 minutes after the injection of 18F-FDG. Results: The histological classifications were as follows: thymoma (n = 49), thymic carcinoma (TC) (n = 19), malignant lymphoma (ML) (n = 8), teratoma (n = 7), thymic cyst (n = 14), and others (n = 8). Upon visual inspection (SUV max: >2.0), all of the malignant tumors showed 18F-FDG accumulation (with the exception of one type A thymoma). Two of the 14 thymic cysts and three of the seven teratomas showed slight 18F-FDG accumulation. The SUV max values of the low-grade thymomas, high-grade thymomas, TCs and MLs were 3.14 ± 0.73, 4.34 ± 1.49, 8.59 ± 3.05, and 10.08 ± 2.53, respectively, with significant differences between the low- and high-grade thymomas, and between TCs and MLs. The sensitivity, specificity and accuracy of 18F-FDG in the detection of low-grade thymomas and thymomas with a maximum diameter of ≤50 mm and an SUV max of ≤3.4 were 85%, 48%, and 60%, respectively. Conclusion: FDG-PET/CT is an objective and useful modality in the differential diagnosis and management of anterior mediastinal tumors.

Squamous cell papillomas are the most common benign tumors of the larynx (1). A solitary bronchial squamous cell papilloma (BSCP) was first reported in 1954 (2). BSCP is a benign tumor originating from squamous cell epithelium cells, and it accounts for 0.38% of all lung tumors (3). There are two primary clinical features of bronchial papillomas. First, BSCP has a tendency to spread to multiple sites within the bronchial tree.

The expression levels of thymidine phosphorylase (TP), dihydropyrimidine dehydrogenase (DPD), thymidylate synthase (TS) and orotate phosphoribosyltransferase (OPRT) may predict the clinical efficacy of 5-fluorouracil-based chemotherapy in patients with cancer. We herein investigated the differences in the mRNA levels of these enzymes in non-small-cell lung cancer (NSCLC) and evaluated their prognostic value for NSCLC treated by surgical resection. The intratumoral mRNA levels of TP, DPD, TS, and OPRT were quantified in 66 patients with pathological stage I and II NSCLC (adenocarcinoma or squamous cell carcinoma) following complete resection according to the Danenberg Tumor Profile method. The TP level was the only significant prognostic factor for disease-specific survival (DSS) following complete resection; the mean TP mRNA level differed significantly between the high and low mRNA expression groups. The DSS at 5 years was significantly higher in the low TP mRNA compared with that in the high TP mRNA expression group (83.4 vs. 58.6%, respectively; P=0.005). A Cox proportional hazards model revealed that pathological stage, sex, and TP expression were independent prognostic factors for DSS in patients with stage I and II NSCLC following complete resection. Thus, TP level may be used to monitor treatment efficacy and predict the outcome of NSCLC patients.

A 65-year-old male was admitted to our hospital for evaluation of an abnormal shadow in the left lung field of chest roentgenogram. A chest computed tomography scan revealed an ill-defined nodule in the superior lingular segment of left lung and a calcified nodule in the left pulmonary apex region. A diagnosis of lung adenocarcinoma in the left lingular was made by transbronchial cytology and the left upper lobectomy with lymph node dissection was performed. Pathological diagnosis was primary lung adenocarcinoma in the superior lingular segment of left lung (pT1aN0M0, stage I A) and hamartoma in the left pulmonary apex region. It was considered to be important to discriminate a hamartoma from a metastasic lesion in order to conduct correct treatment.

Background We conducted a multicenter randomized study of adjuvant S-1 administration schedules for surgically treated pathological stage IB-IIIA non-small cell lung cancer patients. Methods Patients receiving curative surgical resection were centrally randomized to arm A (4 weeks of oral S-1 and a 2-week rest over 12 months) or arm B (2 weeks of S-1 and a 1-week rest over 12 months). The primary endpoints were completion of the scheduled adjuvant chemotherapy over 12 months, and the secondary endpoints were relative total administration dose, toxicity, and 3-year disease-free survival. Results From April 2005 to January 2012, 80 patients were enrolled, of whom 78 patients were eligible and assessable. The planned S-1 administration over 12 months was accomplished to 28 patients in 38 arm A patients (73.7%) and to 18 patients in 40 arm B patients (45.0%, p = 0.01). The average relative dose intensity was 77.2% for arm A and 58.4% for arm B (p = 0.01). Drug-related grade 3 adverse events were recorded for 11% of arm A and 5% of arm B (p = 0.43). Grade 1–3 elevation of bilirubin, alkaline phosphatase, aspartate aminotransferase, and alanine transaminase were more frequently recorded in arm A than in arm B. The 3-year disease-free survival rate was 79.0% for arm A and 79.3% for arm B (p = 0.94). Conclusions The superiority of feasibility of the shorter schedule was not recognized in the present study. The conventional schedule showed higher completion rates over 12 months (p = 0.01) and relative dose intensity of S-1 (p = 0.01). Toxicity showed no significant difference among the shorter schedule and the conventional schedule, except for grade 1–3 elevation of bilirubin. Trial registration This randomized multicenter study was retrospectively registered with the UMIN-CTR (UMIN000016086, registration date December 30, 2014).

The patient, a 65-year-old woman, visited at her local doctor's office with the chief complaint of pharyngeal pain. After being administered antibacterial drugs, hyperthermia persisted and the pharyngeal pain became exacerbated. She was referred to our hospital and diagnosed as a retropharyngeal abscess and descending necrotizing mediastinitis (DNM). She was urgently hospitalized and surgery was performed. The mediastinal pleura was incised with thoracoscopic guidance and curettage, irrigation, and drainage were performed. Additional drainage was determined to be necessary based on findings from subsequent chest computed tomography and a prolonged inflammatory reaction. Therefore, on hospital day 7, 2nd surgery were performed, and tracheotomy was additionally performed with curettage of the neck abscess. The patient was taken off mechanical ventilation on hospital day 18, and discharged on hospital day 55.

The role of cell cycle inhibitors in tumorigenesis has been proven in various neoplasms; however, their roles in thymic tumors are still unclear. We examined the expression of cell cycle inhibitors such as those of the Cip/Kip family (p21, p27, and p57) and the INK-4/ARF family (p16 and p14) in thymoma and thymic carcinoma. Samples from 41 thymoma and 14 thymic carcinoma patients, and 34 normal thymic tissue samples were prepared for the study. Immunohistochemical analysis using antibodies to p21, p27, p57, p16, and p14 was carried out, and the positivity for these inhibitors in each group was estimated in terms of their subcellular location and percentage of cells showing positive staining. Nuclear p27 showed a stepwise decrease (p

Background Myelolipoma is an uncommon tumor comprising adipose tissue and normal hematopoietic cells and mainly occurs in the adrenal cortex. Mediastinal myelolipoma is very rare; we report a case of posterior mediastinal myelolipoma that required surgical resection. Case Presentation A 56-year-old male was diagnosed with a posterior mediastinal tumor by computed tomography. The tumor was originally noted in 2005, and during follow-up in March 2014, it was found to have increased in size. During consultation at our hospital, on magnetic resonance imaging (MRI), we considered the possibility that the tumor was malignant. Consequently, we resected the tumor by video-assisted thoracic surgery (VATS). The histopathological findings revealed that the tumor had undergone intrathoracic extramedullary hematopoiesis. However, after considering the patient’s background and histopathological findings, we diagnosed the tumor as a thoracic extra-adrenal myelolipoma. Conclusions Pathological analysis was instrumental in clarifying the diagnosis. We recommend surgery as a treatment option for posterior mediastinal tumors.

Objective Differentiation of atypical adenomatous hyperplasia (AAH), bronchioloalveolar carcinoma (BAC), and invasive carcinoma on computed tomography (CT) is useful for determining “follow-up or resection” strategies for lesions displaying ground-glass opacity (GGO). The purpose of this study is to evaluate one-dimensional quantitative CT values of GGO on high-resolution CT (HRCT) images using computer-aided diagnosis. Methods Between April 2001 and March 2010, a total of 44 nodules in 42 patients with pure or mixed GGOs ≤2 cm were retrospectively evaluated. Maximum diameter and one-dimensional mean CT (m-CT) value of the diameter were measured using a computer graphics support system (HOPE/DrABLE-EX, Fujitsu, Tokyo, Japan) that displays a CT density profile across the tumor. Results m-CT values were −682 ± 64 HU (range) for AAH lesions, −544 ± 179 (range) for Type A lesions, −496 ± 147 (range) for Type B lesions, and −371 ± 142 (range) for invasive lesions. AAH lesions had a significantly lower m-CT value than Type B lesions. AAH, Type A, and Type B lesions had significantly lower m-CT values than invasive lesions (p 1 cm and m-CT value >−600 HU were invasive lesions. Conclusion Observation may be indicated for GGO lesions with a maximum diameter ≤1 cm and m-CT value ≤−600 HU.

背景．肺癌肉腫は，一般的に予後不良とされる稀な悪性腫瘍である．治療については症例数が少なく，また術前診断が困難であるため，確立されたものがない．症例．64歳男性．血痰を主訴に受診し，右肺に径17 cm大の巨大腫瘤と肺門部リンパ節腫大を指摘された．臨床診断は非小細胞肺癌を疑い，cT3N1M0，stage IIIAと診断した．胸骨正中切開ならびに右横切開を加えて右肺全摘除術を施行した．術後の病理診断でpT3（最大径17 cm）N0M0，stage IIB，肺癌肉腫と診断された．術後は補助療法を施行せずに経過観察していた．術後24ヶ月で肺炎，呼吸不全にて死亡したが，死亡直前まで明らかな再発や遠隔転移を認めなかった．結論．比較的大きな肺癌肉腫に対し完全切除し得た1症例を経験した．術後補助療法を加えることなく2年間無再発であった．予後不良とされる巨大肺癌肉腫においても，完全切除により予後の改善を期待しうることを経験し，文献的考察を加え報告した．

縦隔悪性胚細胞性腫瘍（MGCT）の診断および治療アプローチを再確認するために，切除例の検討を行い，臨床上の問題点を明らかにした．対象は，1993～2006年に昭和大学関連3病院で切除したMGCT8例で，21～69歳，すべて男性．部位は前縦隔6例，中縦隔2例．AFP高値2例，HCG高値1例，両マーカーとも高値1例，上昇なし4例であった．組織検査は，CT下針生検4例，傍胸骨生検1例，縦隔鏡1例，未施行2例で，生検を行った6例中5例で，最終病理と一致した．初回治療は，化療4例（CR2例，PR2例），放治1例（NC），手術3例で，最終病理診断は，Seminoma3例，Yolk sac tumor1例，Adenocarcinoma with teratoma1例，Embryonal carcinoma1例，その他2例であった．MGCTの治療に際しては，化療の効果は良好であることからマーカー陽性例は速やかな抗癌剤治療が必要である．MGCTのなかに比較的高齢者，あるいは中縦隔発生例があることは留意すべき点である．

We report on a 45-year-old woman with intimal sarcoma of the pulmonary artery. She presented with a chief complaint of shortness of breath. Computed tomography (CT) of the chest showed an intraluminal hypoattenuated area extending from the main pulmonary artery into the right main pulmonary artery and bilateral lobar pulmonary arteries. She underwent resection of the lobulated mass from the pulmonary artery. The tumor was diagnosed as an intimal sarcoma. Although she received chemotherapy with amrubicin and carboplatin when the tumor recurred, the tumor enlarged. After radiotherapy was performed, CT of the chest showed shrinkage of the tumor and the regression of consolidation and ground-glass opacity. Radiotherapy and chemotherapy are treatment option for patients with pulmonary artery sarcoma.

他疾患の精査中に前縦隔腫瘍が発見されることはしばしばあるが，ともに手術が必要な心臓疾患と前縦隔腫瘍の合併例の報告は比較的少ない．今回われわれは術中に心嚢内播種が確認された胸腺腫と大動脈弁置換術との同時手術例を経験したので報告する．症例は73歳男性．労作時呼吸困難を主訴に他院を受診．精査の結果大動脈弁閉鎖不全と診断され，また胸部CT上前縦隔腫瘍を指摘された．腫瘍はCTガイド針生検で胸腺腫と診断された．2003年5月手術を施行．腫瘍は心嚢，左腕頭静脈への浸潤を認め，血性心嚢液，心嚢内播種も確認された．腕頭静脈，心嚢を合併切除し腫瘍を摘出したが，不完全切除に終わった．続いて大動脈弁置換術を施行した．胸腺腫の病理はWHO分類Type B3であった．術後縦隔に60Gyの放射線照射を施行した．術後33ヵ月に肺炎呼吸不全で亡くなったが，遺残腫瘍の再増大は緩徐で，また心不全症状はなくQOLは良好であった．

Traumatic diaphragmatic injury (TDI) is relatively rare condition, and is associated with high rates of morbidity and mortality. TDI usually results from blunt trauma and penetrating trauma. The majority causes of blunt TDI are victims of motor vehicle accidents. The incidence rates of TDI is unknown because of it can be overlooked if it is unsuspected with non-specific radiological and clinical findings. The mortality rates associated with blunt and penetrating TDI are affected by the severity of concurrent organ injuries. The diagnoses of TDI are frequently missed in the post-traumatic assessment because of non-specific symptoms or physical findings. When the site of trauma is in the abdomen, there will be high rate of an intra-abdominal organ injury. Furthermore, when the site of trauma is in the chest, there will be the abdominal organ injury in 50%.Surgical operation should be performed as soon as possible for concomitant injuries. Diaphragmatic repair can be performed using laparotomy, thoracotomy, or both approaches. Primary suture of the diaphragm can be performed in the majority of TDI patients. The outcome of post TDI depends on concurrent organ injury. In case of emergency, it is important to take an appropriate diagnosis and treatment for any concomitant injuries.

A 73-year-old woman complained of right chest discomfort. Chest X-ray during the follow-up for rheumatoid arthritis showed a mediastinal tumor. Chest computed tomography (CT) and magnetic resonance imaging (MRI) showed a 65-mm tumor in the right anterior mediastinum. A blood test showed high serum levels of CYFRA 21-1(29.8 ng/ml), white blood cells( WBC 10,800/µl), and C-reactive protein(CRP 16.1 mg/dl). Subsequently, inflammatory reactions improved, and the thymic tumor was resected. Histopathologically, the tumor was a type B2 thymoma with extensive coagulative necrosis. After resection, the serum CYFRA 21-1 level returned to the normal range.

Background In a number of human malignancies, tumor-associated macrophages (TAMs) are closely involved in tumor progression. On the other hand, dendritic cells (DCs) that infiltrate tumor tissues are involved in tumor suppression. However, there have been very few reports on the distribution profiles of TAMs and DCs in thymic epithelial tumors. We examined the difference in the distribution profiles between TAMs and DCs in thymoma and thymic carcinoma. Methods We examined 69 samples of surgically resected thymic epithelial tumors, namely, 16 thymic carcinomas and 53 thymomas, in which we immunohistochemically evaluated the presence of TAMs using CD68 and CD163 as markers and DCs using S100 as the marker in tumor tissue samples in comparison with normal thymic tissues. Results The percentage of samples with a large number of CD68+ TAMs was not significantly different between thymic carcinoma and thymoma (7/16 versus 16/53, p = 0.904). However, the percentage of sample with a large number of CD163+ TAMs was significantly higher in thymic carcinoma than in thymoma (15/16 versus 34/53, p = 0.024). In contrast, the percentage of samples with a large number of S100+ DCs was significantly lower in thymic carcinoma than in thymoma (2/16 versus 23/53, p = 0.021). Conclusions To the best of our knowledge, we are the first to show a high percentage of CD163+ TAMs and a low percentage of S100+ DCs in thymic carcinoma samples, and our findings may provide an idea for future targeted therapeutic strategies for thymic carcinoma using antibodies that inhibit monocyte differentiation to TAMs, thereby skewing TAMs differentiation toward DCs. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_215

The thoracic cage after a lung resection is filled by the remaining lobes, the elevated diaphragm, the diminished thoracic cage, and by mediastinal shifting. The changes in the thorax after a lung resection were quantified using magnetic resonance imaging. The study group consisted of 39 patients who had undergone a lobectomy, four who had undergone a pneumonectomy, and 14 controls. The left ventricular angle, ascending aortic angle, mediastinal shift, longitudinal length of the thoracic cage, the distance between the thoracic apex and the level of the aortic valve, and diaphragmatic elevation were all measured. After a right lower lobectomy, the mediastinum shifted more rightward than after a right upper lobectomy. The diaphragm became more greatly elevated after a right upper lobectomy than after a right lower lobectomy. When a chest wall resection was added to a right upper lobectomy, the mediastinal anatomical changes decreased. After a left upper lobectomy, the degree of mediastinal shifting was greater than after a left lower lobectomy. A left upper lobectomy shifted the mediastinum at the level of the right atrium. This method is easily reproducible and was found to be effective for quantifying the changes in the thorax after a lung resection.