Objective The present study aimed to evaluate the clinical effectiveness of endoscopic bronchial occlusion (EBO) with endobronchial Watanabe spigots (EWSs) for the management of prolonged pulmonary ...air leaks, such as intractable pneumothorax, pyothorax with bronchial fistula, and postoperative air leakage. Methods This was a retrospective study. Between April 2005 and March 2018, we recruited 21 patients with intractable pneumothorax (10 cases), pyothorax with bronchial fistula (7 cases), and postsurgical pulmonary fistula (4 cases) in whom appropriate drainage for 2 weeks had been unsuccessful and who were unsuitable for surgery. An EWS was inserted using a flexible bronchoscope via an endotracheal or a tracheostomy tube. Results The mean number of sessions with EWS procedures was 1.94, and the mean number of inserted EWS per patient was 6.5. In addition to EWS procedures, pleural washing and pleural adhesion therapy were performed in all cases with pyothorax, whereas pleural adhesion therapy was performed in three patients with pneumothorax. The successful treatment rate was 85.7%. Reduction of air leakage was observed in 19/21 patients. The mean duration of reduction of air leaks was 4.1 days (median, 1; range, 0-24 days) following EWS procedures. The mean duration from tube insertion to chest tube removal was 43.4 days (median, 29; range, 16-105 days). Complications included spigot migration and infection (aspergillosis); no complications caused significant mortality. Conclusion Performing EBO using an EWS appears to be a reasonable option for the management of intractable pneumothorax, pyothorax with pulmonary fistula, and postoperative air leakage.
Although traumatic tracheobronchial disruption is rare, the associated mortality is high. A 15-year-old male who had been injured in a traffic accident was transferred to our hospital. On arrival, he ...was unconscious, but retained a normal blood pressure and spontaneous breathing. A chest radiograph showed no finding of pneumothorax, but computed tomography revealed mediastinal emphysema and obstruction of the right main bronchus, indicating bronchial disruption. Although a chest drain was inserted, no air leakage was found. Intracranial injury did not require surgery, so he underwent emergency thoracotomy. Because tracheal intubation using a double-lumen tube was unsuccessful, tracheostomy was carried out to insert a 6.5-mm spiral tube into the left main bronchus. We performed posterolateral thoracotomy, divided the azygos vein following mediastinal pleurotomy, and found complete transection of the right main bronchus. The main bronchus was repaired by end-to-end anastomosis with partial debridement of the edges. No postoperative anastomotic complication occurred. He was transferred for neurological rehabilitation due to prolonged disturbance of consciousness nineteen weeks after surgery.
Background
Multiple primary malignancies of breast cancer and diffuse large B-cell lymphoma (DLBCL) are rare. Here, we report a case of advanced breast cancer and DLBCL managed with multidisciplinary ...therapy preceded by surgery with a successful outcome.
Case presentation
During a medical examination, a 71-year-old woman was diagnosed with a right breast mass, enlarged lymph nodes throughout the body, and a splenic tumor. The results of the clinical examination and imaging were suggestive of widely spread breast cancer with lymph node metastasis and malignant lymphoma with systemic metastasis. The histological evaluation of the biopsied breast tissue revealed human epidermal growth factor receptor 2 (HER2)-positive breast cancer, whereas the histological evaluation of the excised inguinal lymph node revealed DLBCL.
18
F-FDG PET/computed tomography was performed, and it was determined that both breast cancer and DLBCL were in an advanced stage. Thus, mastectomy was performed, and the axillary lymph nodes showed mixed metastasis of breast cancer and DLBCL. Soon after, the R-CHOP therapy was initiated (375-mg/m
2
rituximab, 2-mg/m
2
vincristine, 50-mg/m
2
doxorubicin, 750-mg/m
2
cyclophosphamide, and 125-mg methylprednisolone). After irradiation of the spleen, trastuzumab was administered for 1 year.
Conclusions
We experienced a case of combined breast cancer and DLBCL, which was difficult to treat because both were in advanced stages. Thorough staging of the malignancy and discussion by a multidisciplinary team are necessary to determine the optimal treatment strategy.
A 51-year-old man underwent video-assisted thoracoscopic (VATS) bullectomy for right pneumothorax. Although preoperative computed tomography showed no nodule in a bulla, the pathological diagnosis ...based on a surgical specimen was pulmonary spindle cell carcinoma with tumor invasion beyond fibrous thickened pleura. No cancer cells were found in the resection stump. In addition, we performed VATS right upper lobectomy with hilar and mediastinal lymphadenectomies.Microscopic examination showed no remnant cancer cells in either the resected right upper lobe or lymph nodes. The patient was eventually diagnosed with spindle cell carcinoma, pT2aN0M0, Stage IB. He started taking oral uracil/tegaful 4 weeks after the additional surgery. He complained of dyspnea and backache 16 weeks postoperatively, and was diagnosed with recurrence of pleural dissemination and distant metastases. We immediately performed chemotherapy, but he died 18 weeks postoperatively. Lung cancer pathologically identified by pneumothorax surgery is rare. Thus, it is important to be aware of the coexistence of lung cancer and pneumothorax and consider early radical surgery owing to the poor prognosis.
We report the case of a 37‐year‐old pregnant Japanese woman (34th week of gestation) with a left main bronchus mucoepidermoid carcinoma. She had left lower lung pneumonia episodes for eight weeks ...that had been associated with bronchial asthma. Bronchoscopy revealed a membranous endobronchial tumour obstructing most of the left main bronchus. We delivered the baby without any problems by caesarean section, followed by tumour cauterization using a rigid bronchoscope under general anaesthesia. After that, we performed a sleeve resection of the main left bronchus. At one‐year follow‐up, the patient was disease‐free and her baby was growing well.
Here, we report the case of a 37‐year‐old pregnant Japanese woman with bronchial mucoepidermoid carcinoma, recurrent asthmatic symptoms, and pneumonia that we treated successfully via interventional bronchoscopy and surgery. At one‐year follow‐up, the patient was disease‐free and her baby was growing well.
Objective Despite the remarkable advances in chemotherapy and allogeneic hematopoietic stem cell transplantation (HSCT), adult T-cell leukemia-lymphoma (ATL) is still associated with a high mortality ...rate. It is therefore essential to elucidate the current features of ATL. Methods We retrospectively analyzed 81 patients with aggressive type ATL at our institution over a 7-year period based on Shimoyama's diagnostic criteria. Results Eighty-one patients with a median age of 67.5 years were classified as having acute (n=47), lymphoma (n=32), or chronic type (n=2) ATL. They were initially treated by either palliative therapy (n=25) or systemic chemotherapy n=56; cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy (n=25)/vincristine, cyclophosphamide, doxorubicin, and prednisone (VCAP)-doxorubicin, ranimustine, and prednisone (AMP)-vindesine, etoposide, carboplatin, and prednisone (VECP) therapy (VCAP-AMP-VECP) or CHOP-VMMV therapy (n=31), and showed median survival durations of 16 and 277 days, respectively. Subsequent to the initial treatment, HSCT (n=6) was performed for certain patients, thus revealing that two-thirds (n=4) relapsed, and one-third (n=2) survived for 131 days and 203 days, respectively. The relapsed ATL patients were treated with conventional salvage therapy (n=29) or anti-CC chemokine receptor 4 antibody (mogamulizumab) (n=3). The patients treated with mogamulizumab demonstrated complete response (2) and partical response (1) with short duration periods of 82 days, 83 days, and 192 days, respectively. Among the five long-term survivors (>5 years) who received chemotherapy, most showed a low and intermediate risk according to the ATL prognostic index. Conclusion In our study, the overall survival of ATL remains poor due to the advanced age of the patients at diagnosis, a high proportion of patients receiving palliative therapy, and a small proportion of long-term survivors receiving chemotherapy and undergoing HSCT. This study illustrates the current clinical features, treatment strategies, and outcomes in clinical practice.
Objective Disseminated intravascular coagulation (DIC) is a clinical condition with high mortality that is characterized by the systemic activation of coagulation pathways resulting in multiple organ ...failure. Although no standard treatment for DIC has been established, recent reports have indicated that recombinant human soluble thrombomodulin (rTM) is effective against DIC. Methods To elucidate the clinical characteristics and outcomes of DIC, we retrospectively analyzed 92 DIC patients who were treated with rTM at Miyazaki Prefectural Hospital over a 4-year period (62 patients had infectious diseases and 30 patients had hematological diseases). A diagnosis of DIC was made based on the diagnostic criteria of the Japanese Association for Acute Medicine (JAAM) and Japanese Ministry of Health and Welfare (JMHW) for infectious diseases and hematological diseases, respectively. In addition to treating the underlying disease, rTM was administered for six consecutive days. Results In this study, 49 of the 92 DIC patients (53.3%) experienced resolution of DIC seven days after administration (46.8% patients with infectious disease and 66.7% with hematological disease). A higher survival rate was observed after a 28-day observation period in 69 of the 92 patients (75.0%) (72.6% of the patients with infectious disease and 80.0% of the patients with hematological disease). A lower DIC score at the initiation of rTM treatment was closely related to a higher rate of resolution of DIC. Conclusion Our findings indicate that rTM therapy is an effective, safe and feasible treatment for DIC patients. Furthermore, making an accurate and early diagnosis of DIC and providing subsequent immediate treatment with rTM may improve the resolution of DIC.
Crystal-storing histiocytosis is a rare clinical entity characterized by an increase in the number of abnormal histiocytes accompanied by accumulation of crystallized immunoglobulins. We describe the ...case of an 80-year-old man who presented with crystal-storing histiocytosis of the lung 13 years after receiving a diagnosis of gastric non-Hodgkin lymphoma (NHL ; clinical stage, Lugano IA). After wedge resection of the left upper lobe, the histological findings showed crystal-storing histiocytosis with CD68+, some small to medium lymphoid cells with CD79a+ with κ+(weekly) and λ-, and some plasma cells with CD138+, and rearrangement of the immunoglobulin heavy chain. Based on the nonrecurrent gastric NHL, small B-cell population, and failure to detect the same clone by polymerase chain reaction analysis, our case was classified as pulmonary localized crystal-storing histiocytosis without underlying lymphoproliferative or plasma cell disorder. The findings of minor B-cell populations harboring a heavy chain rearrangement with slight light-chain restriction (κ > λ) may be related to the pathogenesis of crystallogenesis and crystal-storing histiocytosis. Moreover, surgical treatment may be an effective therapeutic option for solitary crystal-storing histiocytosis. J Clin Exp Hematop 53(3) : 241-245, 2013
Immunodeficiency-associated lymphoproliferative disorders (LPD) in rheumatoid arthritis are a rare, aggressive, and life-threatening clinical entity. We describe a 60-year-old man who had rheumatoid ...arthritis that was treated with methotrexate. Eight months after the treatment, the case was diagnosed as Epstein-Barr virus-negative LPD (diffuse large B-cell lymphoma) with abdominal bulky mass and clinical stage IVB at high risk in the international prognostic index. Immediate withdrawal of methotrexate led the patient to achieve complete remission, and 8 subsequent courses of rituximab treatment for the prevention of relapse kept the patient disease-free for 29 months. Our case suggests that these treatments may be an effective, safe, and feasible strategy for immunodeficiency-associated LPD in rheumatoid arthritis. J Clin Exp Hematopathol 52(3) : 193-198, 2012
Lymph node metastasis from pulmonary typical carcinoid is rare. A 72-year-old man was pointed out a mass shadow with a screening cheat X-ray. A chest computed tomography (CT) showed a 3.1-cm lung ...tumor in the left lower lobe, which was suspected pulmonary carcinoid with bronchoscopy. Positron emission tomography (PET) revealed an abnormal FDG uptake in the tumor not but any other site. Although he was diagnosed with cT2aN0M0 : Stage IB lung cancer, he rejected surgery. Because the tumor was slightly enlarged during strict observation, he agreed to surgery and underwent left lower lobectomy and hilar and mediastinal lymph node dissection. Pathological findings showed tumor tissue with neither mitosis nor necrosis, tumor cells positive for chromogranin A and a metastatic hilar lymph node, leading to the diagnosis of typical carcinoid, pT2aN1M0 : Stage IIB. He had an uneventful postoperative recovery and was transferred to another institute for rehabilitation eight days after the surgery. We should carefully decide a surgical strategy based on the potential of pulmonary typical carcinoid to metastasize to lymph nodes.
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