We report two surgical cases of pneumothorax caused by COVID-19 pneumonia due to new occurrence of bullae or blebs. Case 1: The patient was a man in his late 50s with no history of smoking. He had ...recovered from severe COVID-19 with the administration of oxygen, remdesivir, and dexamethasone; however, he developed right pneumothorax on the 21st day after onset and required emergency hospitalization. Computed tomography (CT) showed a lung cyst that was not found during the treatment for pneumonia. The patient's condition did not improve with drainage treatment, and he underwent thoracoscopic pulmonary cystectomy on the 10th day of admission. The pathological diagnosis was a bleb with active inflammatory changes. Case 2: The patient was a man in his early 60s with no history of smoking. Severe illness due to COVID-19 was treated, and the patient recovered as in case 1; however, on the 36th day after onset, he developed left pneumothorax and was urgently hospitalized. CT showed a lung cyst that was not found during the treatment for pneumonia. The patient's condition did not improve with drainage treatment, and he underwent thoracoscopic pulmonary cystectomy on the 20th day of admission. The pathological diagnosis was fibroelastosis, a bulla, and the healing process of bleeding and hematoma.
Background. Myocardial metastases from lung cancer are rare. We herein report a case of T790M-positive lung adenocarcinoma for which osimertinib therapy was effective. Case. A 66-year-old woman ...underwent right upper lobectomy for lung adenocarcinoma (cT2aN0M0 cStage IB). The pathological stage was pT2a (pl1) N2M0 pStage IIIA; it was EGFR-positive (exon19 deletion) adenocarcinoma with a mixed subtype. She refused to undergo postoperative adjuvant chemotherapy, and four months after the operation, the lung cancer recurred in the mediastinal lymph node. She then received therapy with gefitinib. Nine months after the start of the treatment, bone (skull) metastasis appeared, and the patient was hospitalized. On admission, abnormal changes on the electrocardiogram led us to suspect myocardial infarction. On echocardiography and computed tomography, a mass was noted in the myocardium of the left ventricle and the interventricular septum; this was diagnosed as myocardial metastasis, and treatment with osimertinib was initiated. Four-month treatment shrank the mass, and the abnormal changes that had been observed on the electrocardiogram subsequently disappeared. Conclusion. We herein report an uncommon case of lung cancer with myocardial metastasis that presented with abnormal findings, mimicking acute myocardial infarction, on the electrocardiogram. Furthermore, in this case, osimertinib reduced the tumor size and improved the abnormal electrocardiogram findings.
Radiological finding of pulmonary metastasis of thyroid cancer is generally known to be multiple small nodular shadow. We experienced 2 cases of lung solitary tumor, which were suspected of primary ...lung cancer as differential diagnosis. Patient 1:A 67-year-old man;the tumor obstructed subsegmental bronchus (B10) of the right lobe, and pathological diagnosis by transbronchial biopsy was adeno-squamous carcinoma. Fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) showed abnormal uptake in the tumor and also in the left lobe of his thyroid gland, but no malignant findings were found by the fine-needle aspiration cytology from the thyroid gland. Patient 2:A 51-year-old woman;she had a lobulated nodule in the left lower lobe, which was diagnosed as adenocarcinoma. She had undergone an operation for thyroid cancer about 30 years earlier, but after the operation, there has been no recurrence. In both cases, primary lung cancer were suspected and the tumors were resected surgically. By immunohistochemistry, both tumors were diagnosed as pulmonary metastases from papillary thyroid carcinoma.
A 30-year-old woman who presented loss of consciousness was diagnosed as having large anterior mediastinal tumor. Computed tomography (CT) showed a 17.0×13.0×7.3 cm cystic mass with internal ...calcification in the anterior mediastinum that was markedly compressing the heart, great vessels, trachea and bronchi. A mature cystic teratoma was suspected, and the mediastinal tumor was resected through a median sternotomy. At the induction of anesthesia to prevent the development of the respiratory and circulatory collapse, the patient was consciously intubated under the right lateral decubitus position while preparing for percutaneous cardiopulmonary support by cardiac surgeons, and the surgery was safely performed. The tumor was pathologically diagnosed as a mature cystic teratoma, and symptoms such as loss of consciousness have disappeared.
A 48-year-old man was referred to our hospital because of an abnormal shadow on a chest radiograph. Carcinoembryonic antigen was slightly high. Chest computed tomography revealed a 50-mm tumor in the ...right upper lobe, and an accumulation of fluorodeoxyglucose was observed in the mass by positron emission tomography. A definitive diagnosis could not be obtained by CT-guided percutaneous needle biopsy, and the possibility of lung cancer could not be ruled out. So, we performed lobectomy for diagnosis and treatment. Mycobacterial staining and culture of the sample obtained from the right upper lobe was positive. The infectious agent was identified as Mycobacterium xenopi by the DNA-DNA hybridization method. He administered chemotherapy after the operation, and no recurrence has been observed to date.
Ovjectives and subjects: The subjects were 70 patients who underwent endoscopic microwave coagulation therapy in Ashikaga Red Cross Hospital between January 2001 and December 2010. They were ...classified into the four categories below, and the usefulness of therapy and treatment limitations were evaluated: 1. Malignant airway stenosis 2. Benign airway stenosis 3. Radical ablation for early stage central lung cancer 4. Coagulation therapy for visible bleeding Results: Of the subjects, 56 had malignant airway stenosis, 11 benign airway stenosis, 1 early stage central lung cancer, and two had visible bleeding. Conclusion: Cases treatable with endoscopic microwave coagulation therapy alone are limited regardless of whether malignant or benign, and such therapy is conducted before or after surgery or other endoscopic treatments. It was considered that, in adjunctive local therapy aimed at improving ventilator impairment and controlling bleeding, endoscopic microwave coagulation therapy is useful to relieve dyspnea and improve the QOL.
A 65-year-old female was admitted to our hospital because of bilateral pleural and pericardial effusion. She underwent pacemaker implantation elsewhere for complete A-V block at age 60, ...re-implantation at age 61 due to pacemaker pocket infection, and was treated with antibiotics for idiopathic mediastinitis at age 65. She was diagnosed with bilateral chylothoraces and chylopericardium by thoracocentesis and pericardiocentesis. Bilateral pleural drains and a pericardial drain were inserted. Neither lymphangiography nor radioisotope lymphography revealed the site of chyle leakage. Her pleural and pericardial effusion did not decrease in spite of a low-fat diet. So, she underwent thoracoscopic ligation of the thoracic duct and pericardiotomy through the right thorax. After the surgery, pericardial effusion disappeared but pleural effusion persisted. She developed respiratory failure because of pleural effusion, and had to undergo thoracocentesis repeatedly. As her malnutrition progressed gradually due to the loss of chyle, bilateral pleuroperitoneal shunt (using Denver Shunt®) was performed 84 days after the first surgery. Bilateral pleural effusion was well controled, her nutrition status recovered, and no further therapeutic intervention for chylothorax was required. She underwent removal of the initially inplanted pacemaker lead due to a subsequent septic episode 17 months after the shunt operation, and no further pumping of the shunt tube was needed thereafter. This is a rare case in which the pacemaker lead was a possible cause of chylothorax. We think that pleuroperitoneal shunt can be an effective therapy for persistent chylothorax.
Pulmonary metastasectomy (PM) for breast cancer-derived pulmonary metastasis is controversial. This study aimed to assess the prognostic factors and implication of PM for metastatic breast cancer ...using a multi-institutional database.
Clinical data of 253 females with pulmonary metastasis of breast cancer who underwent PM between 1982 and 2017 were analyzed retrospectively.
The median patient age was 56 years. The median follow-up period was 5.4 years, and the median disease-free interval (DFI) was 4.8 years. The 5- and 10-year survival rates after PM were 64.9% and 50.4%, respectively, and the median overall survival was 10.1 years. Univariate analysis revealed that the period of PM before 2000, a DFI <36 months, lobectomy/pneumonectomy, large tumor size, and lymph node metastasis were predictive of a worse overall survival. In the multivariate analysis, a DFI <36 months, large tumor size, and lymph node metastasis remained significantly related to overall survival. The 5- and 10-year cancer-specific survival rates after PM were 66.9% and 54.7%, respectively, and the median cancer-specific survival was 13.1 years. Univariate analyses revealed that the period of PM before 2000, DFI <36 months, lobectomy/pneumonectomy, large tumor size, lymph node metastasis, and incomplete resection were predictive of a worse cancer-specific survival. Multivariate analysis confirmed that a DFI <36 months, large tumor size and incomplete resection were significantly related to cancer-specific survival.
As PM has limited efficacy in breast cancer, it should be considered an optional treatment for pulmonary metastasis of breast cancer.
PDF
