Locally infiltrative glomus tumor of the bronchus: a case report

We report a glomus tumor of the bronchus that showed invasion of the neural area and extrabronchial extension without significant histological malignancy. The patient was a male in his late 30s with the chief complaint being hemosputum. CT revealed a nodal shadow 15 mm in diameter in the right bronchus intermedius. An irregularly protruding lesion on the tumor surface was observed by bronchoscopy immediately under the second carina in the right truncus intermedius, but could not be diagnosed because of bleeding. Sleeve lobectomy of the right upper lobe was performed, since carcinoid tumor was suspected in open chest biopsy and intraoperative frozen section diagnosis. A solid growth of spherical and cubic uniform cells with a clear eosinophilic cytoplasm and spherical nuclei was observed. Immunohistochemistry was positive for α-smooth muscle actin and type IV collagen, weakly positive for synaptophysin, and negative for keratin, neural cell adhesion molecule, chromogranin A, desmin, CD34, and S100, leading to a diagnosis of glomus tumor. Neuroinvasion and extrabronchial tumor extension were observed, but an atypical cytology, bleeding, or necrosis was found histologically. This is the first description of infiltrative glomus tumor of the bronchus.

Surgical results of lung cancer associated with postobstructive pneumonia

PURPOSE

We report surgical results of lung cancer associated with postobstructive pneumonia.

MATERIALS AND METHODS

We report on morbidity and mortality, and we analyze the risk factors for them and the prognostic factors for overall survival of patients without mortality.

RESULTS

Morbidity developed in 13 of the 38 patients (34.2%). Mortality rate was 10.5%. Hemoglobin concentration before surgery and predicted postoperative forced expiratory volume in one second were significantly low in patients with morbidity and mortality based on the univariate analyses. Predicted postoperative forced expiratory volume in one second was a significant risk factor for morbidity based on a multivariate analysis. Poor prognostic factors for overall survival were serum albumin concentration, hemoglobin concentration, and performance status before surgery, combined resection, and pathological stage. Serum albumin concentration was significant based on a multivariate analysis.

CONCLUSIONS

Morbidity and mortality are high in patients with lung cancer associated with postobstructive pneumonia. Morbidity demonstrates significant association with low predicted postoperative forced expiratory volume in one second and hemoglobin concentration, indicating the need for preoperative transfusion in severe anemia or bronchoplasty if possible. Poor nutritional state before surgery possibly derived from cachexia may influence not only morbidity and mortality, but also prognosis.

Octopus gonadotrophin-releasing hormone: a multifunctional peptide in the endocrine and nervous systems of the cephalopod

The optic gland, which is analogous to the anterior pituitary in the context of gonadal maturation, is found on the upper posterior edge of the optic tract of the octopus Octopus vulgaris. In mature octopus, the optic glands enlarge and secrete a gonadotrophic hormone. A peptide with structural features similar to that of vertebrate gonadotrophin-releasing hormone (GnRH) was isolated from the brain of octopus and was named oct-GnRH. Oct-GnRH showed luteinising hormone-releasing activity in the anterior pituitary cells of the Japanese quail Coturnix coturnix. Oct-GnRH immunoreactive signals were observed in the glandular cells of the mature optic gland. Oct-GnRH stimulated the synthesis and release of sex steroids from the ovary and testis, and elicited contractions of the oviduct. Oct-GnRH receptor was expressed in the gonads and accessory organs, such as the oviduct and oviducal gland. These results suggest that oct-GnRH induces the gonadal maturation and oviposition by regulating sex steroidogenesis and a series of egg-laying behaviours via the oct-GnRH receptor. The distribution and expression of oct-GnRH in the central and peripheral nervous systems suggest that oct-GnRH acts as a multifunctional modulatory factor in feeding, memory processing, sensory, movement and autonomic functions.

Hereditary factors in multiple primary malignancies associated with lung cancer

PURPOSE

There are differences between lung cancer alone and multiple primary malignancies associated with lung cancer (MPMLC) in terms of clinical characteristics. However, the importance of these differences has not yet been clarified.

METHODS

Univariate and multivariate analyses were performed on 123 patients with MPMLC and 815 patients with lung cancer alone who underwent operative procedures for lung cancer from August 1982 to March 2004.

RESULTS

Age, number of family with a family history of other malignancies except for smoking-related cancers, and pathological early stage of lung cancer were significantly high in patients with MPMLC based on univariate analyses (P < 0.0001, P < 0.05, and P < 0.05, respectively). Age and family history of malignancy were thus found to be significant factors based on a multivariate analysis.

CONCLUSIONS

MPMLC demonstrated a significant association with advanced age and stronger hereditary factors in comparison with lung cancer alone, indicating the need for different approaches to properly manage and follow up risk patients.

Ciprofloxacin Penetration into the Pulmonary Parenchyma in Japanese Patients

PURPOSE

To assess the degree of penetration of intravenous (i.v.) ciprofloxacin into the lung parenchyma resected for lung carcinoma in Japanese patients.

METHODS

Ciprofloxacin was given i.v. over 1 h to ten Japanese patients with non-small cell lung carcinoma. We took 1 g of normal lung parenchyma and 1 ml of blood serum for analysis when the lung was resected. Ciprofloxacin concentrations were determined by high-performance liquid chromatography.

RESULTS

The mean time from the end of ciprofloxacin administration to lung resection was 135 +/- 55 min (range, 75-223 min). The mean concentrations of ciprofloxacin in the lung parenchyma and blood serum were 4.9 +/- 2.0 microg/g (range, 2.1-7.9) and 1.5 +/- 0.7 microg/ml (range, 0.8-2.7). The mean tissue per serum concentration ratio was 3.6 +/- 2.2 (range, 1.9-8.7).

CONCLUSION

The concentrations of ciprofloxacin in the lung parenchyma after i.v. administration in Japanese patients were above the minimal inhibitory concentration for bacteria from at least 75 min until 4 h later.

Dissimilarity in gene expression profiles of lung adenocarcinoma in Japanese men and women

BACKGROUND

Although clinical differences in lung cancer between men and women have been noted, few studies have examined the sex dissimilarity using gene expression analysis.

OBJECTIVE

The purpose of this study was to determine the different molecular carcinogenic mechanisms involved in lung cancers in Japanese men and women.

METHODS

Patients who received surgery for stage I lung adenocarcinoma were included. RNA was extracted from cancerous and normal tissue, and gene expression was then examined with oligonucleotide microarray analysis. A quantitative polymerase chain reaction assay was performed.

RESULTS

In a microarray analysis of tissue from 13 men and 6 women, 12 genes were under-expressed and 24 genes were overexpressed in lung adenocarcinoma in women compared with men. Genes related to cell cycle were present in underexpressed genes, and genes related to apoptosis, ubiquitination, and metabolism were observed in overexpressed genes. Of interest among the selected genes were WAP four-disulfide core domain 2 (WFDC2) and major histocompatibility complex, class II, DM alpha (HLA-DMA); these genes were classified into 2 groups by hierarchical clustering analysis. Expression of WFDC2 in nonsmokers was significantly higher than that in smokers (P=0.023). However, there was no significant difference in HLA-DMA expression between smokers and nonsmokers.

CONCLUSION

Thirty-six genes that characterize lung adenocarcinoma by sex were selected. This information may contribute to the development of novel diagnostic techniques and treatment modalities that consider sex differences in lung adenocarcinoma.

Resection of sternal metastasis from endometrial carcinoma followed by reconstruction with sandwiched marlex and stainless steel mesh: report of a case

We report the successful resection of sternal metastasis from endometrial carcinoma, followed by reconstruction of the chest defect, in an 87-year-old woman. We performed subtotal sternectomy and concurrent resection of the ribs and overlying soft tissue. The skeletal defect was then reconstructed with sandwiched Marlex and stainless steel mesh, and soft tissue coverage was accomplished by using a pectoralis major advancement flap. The patient had an uneventful postoperative course with no sign of recurrence during 5 years of follow-up. Thus, reconstruction with Marlex and stainless steel mesh could be an effective technique for preventing paradoxical movement of the thorax and protecting the intrathoracic organs.

Resection of sternal tumors and reconstruction of the thorax: a review of 15 patients

PURPOSE

We report our experience of resecting sternal tumors, followed by reconstruction of the skeletal and soft-tissue defects, and discuss the usefulness of sandwiched Marlex and stainless-steel mesh.

METHODS

Fifteen patients underwent resection of a sternal tumor and chest wall reconstruction with autologous bone grafts, sandwiched Marlex and stainless-steel mesh or a titanium plate, and musculocutaneous flaps. The sternal tumors were from locally recurrent breast carcinoma in ten patients, metastasis from other organs in three, and primary chondrosarcoma in two.

RESULTS

All patients were extubated without paradoxical respiration just after surgery. There was no operative mortality. A wound infection developed in the acute phase after a sandwiched Marlex and stainless-steel mesh reconstruction in one patient. A second repair with Marlex and stainless-steel mesh was required in two patients; for flail chest after an autologous bone graft in one; and following re-recurrence of breast carcinoma in another patient who had undergone a musculocutaneous flap repair. No signs of breakdown, dislodgment, severe depression, or deformity were seen in any of the six patients who underwent reconstruction with Marlex and stainless-steel mesh during a median follow-up period of 56 months.

CONCLUSIONS

Wide resection of sternal tumors provides good local control. Reconstruction with Marlex and stainless-steel mesh seems to be the most effective technique for repairing a wide anterior chest wall defect.

Enucleation of Esophageal Leiomyoma with Azygos Continuation of the Inferior Vena Cava: Report of a Case

We herein report a rare case of esophageal leiomyoma in an 18-year-old woman with azygos continuation of the inferior vena cava. A submucosal tumor was located in the left wall of the esophagus behind the carina. The enlarged azygos vein made video-assisted thoracic surgery so difficult that conversion to a minithoracotomy and transection of the right superior intercostal vein were necessary to fully visualize the tumor. A pathological diagnosis revealed leiomyoma. Our experience suggests that a transection of the right superior intercostal vein is effective for the proper exposure of an esophageal tumor located behind the carina in a patient with an enlarged azygos vein.

Characteristics of Multiple Primary Malignancies Associated with Lung Cancer by Gender

BACKGROUND

There are gender differences in multiple primary malignancies associated with lung cancer (MPMLC) in terms of clinical characteristics. However, the importance of these differences in the management of patients has not been clarified.

OBJECTIVE

Differences in characteristics affected by gender were investigated in MPMLC to identify factors important for the proper management of the patients.

METHODS

Univariate and multivariate analyses were performed between 82 male and 34 female patients with MPMLC treated from August 1982 to March 2002.

RESULTS

In univariate analysis, the numbers of smokers or ex-smokers, smoking-related cancer and synchronous multiple primary malignancies were significantly increased in males with MPMLC (p < 0.0001, p < 0.05 and p < 0.05, respectively). In multivariate analysis, synchronous multiple primary malignancies and the number of smokers or ex-smokers were significantly different between male and female MPMLC. Gastric, lung and colon cancers were major constituents in male MPMLC, and 40.2% of all malignancies were smoking-related cancers. On the other hand, breast and uterine cancers were major constituents in female MPMLC, and only 20.6% of all MPMLC were smoking-related cancers.

CONCLUSIONS

Male patients with MPMLC demonstrated significant smoking history and synchronous multiple primary malignancies, indicating the need for different approaches to properly manage and follow up male versus female MPMLC patients.

Metastatic chest wall tumor suspected to be of lung origin by immunoreactivity for cytokeratin 7 and 20

We report a rare case of unknown primary carcinoma. A 36-year-old man was admitted to the hospital because of a chest wall tumor. Serum carcinoembryonic antigen level was 160 ng/ml. The resected chest wall tumor was pathologically diagnosed as metastatic adenocarcinoma, showing positive immunoreactivity for cytokeratin 7 and negative immunoreactivity for cytokeratin 20, suggesting lung origin. Serum carcinoembryonic antigen level returned to normal limits. Twenty-one months later, a chest X-ray showed a nodular lesion in the left upper lobe and serum carcinoembryonic antigen level increased to 12.3 ng/ml. Left upper lobectomy was performed 23 months after chest wall resection. The resected tumor was pathologically diagnosed as primary lung adenocarcinoma, showing the same immunoreactivity as in the chest wall tumor. The combination of immunohistochemistry for cytokeratin 7 and 20 appeared to be a useful tool in determining the site of origin and helpful for premortem diagnosis of the origin of unknown primary carcinoma.

Analysis of Risk Factors for Postpneumonectomy Bronchopleural Fistulas in Patients with Lung Cancer

BACKGROUND

Bronchopleural fistula is a potentially fatal complication of pulmonary resections, especially pneumonectomy.

METHODS

Univariate and multivariate analyses of the development of bronchopleural fistula were performed in 12 patients with bronchopleural fistula and 102 patients without bronchopleural fistula who had undergone pneumonectomy from January 1983 through December 2005.

RESULTS

Bronchopleural fistula developed after pneumonectomy in 12 patients (8.5%). Seven (58.7%) of the 12 patients died of bronchopleural fistula. Univariate analysis showed that preoperative infection, right pneumonectomy, and pathological N2, 3 disease significantly contributed to the development of postpneumonectomy bronchopleural fistula (p=0.0002, p=0.0043, and p=0.0387, respectively). Multivariate analysis also showed that preoperative infection, right pneumonectomy, and pathological N2, 3 disease were significant risk factors for postpneumonectomy bronchopleural fistula.

CONCLUSIONS

Bronchopleural fistula is strongly associated with preoperative infection, right pneumonectomy, and pathological N2, 3 disease. Bronchial stump coverage with pedicled tissue flaps and preservation of the bronchial arteries during mediastinal lymph node dissection are recommended to maintain the blood supply to the bronchial stump in patients at risk.

Determining the plasma concentration of ketamine that enhances epidural bupivacaine-and-morphine-induced analgesia

N-methyl-D-aspartate (NMDA) receptor antagonists enhance opioid-induced analgesia. The plasma concentration of ketamine, an NMDA receptor antagonist that enhances epidural morphine-and-bupivacaine-induced analgesia, is not known. We examined 24 patients with lung carcinoma or metastatic lung tumor who underwent video-assisted thoracic surgery in a placebo-controlled, double-blind manner 4 h after emergence from anesthesia. The morphine + ketamine group (n = 8) and morphine + placebo group (n = 8) received 5 mL volume of 2.5 mg morphine and 0.25% bupivacaine and the placebo + ketamine group (n = 8) received 5 mL volume of saline and 0.25% bupivacaine epidurally at the end of skin closure. Four hours after this anesthesia, in the morphine + ketamine and placebo + ketamine groups, ketamine was administered to successively maintain a stable plasma ketamine concentration of 0, 10, 20, 30, 40, and 50 ng/mL by a target-controlled infusion device, and patients assessed the levels of pain at rest, pain on coughing, somnolence (drowsiness), and nausea using a 100-mm visual analog scale (VAS). In the morphine + placebo group, a placebo (saline) was similarly administered instead of ketamine. In the morphine + ketamine group, the VAS scores for pain at rest and pain on coughing significantly decreased on ketamine administration at a plasma concentration of 20 ng/mL or larger compared with the respective baseline VAS scores (P < 0.05 each). In the placebo + ketamine group, the VAS scores for pain at rest and pain on coughing did not significantly change at any plasma concentration of ketamine as compared to the morphine + placebo group. In the morphine + ketamine group, a plasma concentration of ketamine larger than 20 ng/mL did not further reduce VAS scores for pain at rest and pain on coughing. The VAS scores for drowsiness were comparable among the three groups at any plasma concentration of ketamine. Ketamine at a plasma concentration of 20 ng/mL or larger may enhance epidural morphine-and-bupivacaine-induced analgesia. As an adjunct with epidural morphine-and-bupivacaine and considering the safety of small doses, the minimal plasma concentration of ketamine given IV may be approximately 20 ng/mL.

Prognostic significance of the tumor suppressor gene maspin in non-small cell lung cancer

BACKGROUND

Maspin is a serpin protease inhibitor, which is known to suppress tumor progression in breast cancer and to be regulated by wild-type p53. This study was performed to elucidate the biologic significance of maspin expression in non-small cell lung cancer.

METHODS

To investigate whether maspin is involved in progression, clinicopathologic features, and prognosis of non-small cell lung cancer, we performed an immunohistochemical study using antimaspin antibody and identified the presence of maspin messenger ribonucleic acid in cancerous and noncancerous tissues by reverse transcription-polymerase chain reaction analysis. In addition, we evaluated p53 expression immunohistochemically on the serial sections.

RESULTS

Most adenocarcinoma and squamous cell carcinoma showed cytoplasmic staining pattern. The cytoplasmic positive rate was 77.8% (42 of 54 specimens) for the stage III group, and 36.2% (21 of 58 specimens) for the stage I group (p < 0.0001). Three-year survival rates after operation were 30.8% for the maspin-positive group and 71.1% for the maspin-negative group (p = 0.007). In multivariate analysis, immunohistochemical maspin expression in patients with non-small cell lung cancer was an independent prognostic factor for overall survival. No correlation between maspin and p53 expression in cancer cells could be observed. There was an average fourfold increase in maspin messenger ribonucleic acid levels in cancerous tissues compared with those of noncancerous tissues, and stage III cases exhibited significantly higher maspin messenger ribonucleic acid levels than stage I cases (p = 0.003).

CONCLUSIONS

The results of this study suggest that overexpression of maspin in cytoplasm may be a useful marker of tumor progression and unfavorable prognosis for overall survival in some patients with non-small cell lung cancer. Furthermore, maspin expression in cytoplasm appears to be unaffected by p53.

Surgical Treatment of Superior Sulcus Tumors

PURPOSE

To access the clinical outcome of patients with superior sulcus tumor.

METHODS

We reviewed the records of 16 patients who underwent surgery for a superior sulcus tumor between 1988 and 2003, focusing on the type of surgery.

RESULTS

All 16 patients underwent en bloc lung and chest wall resection, which was done as pneumonectomy in 1 patient and lobectomy in 15. Complete resection was achieved in 11 patients, but incomplete resection was done in 5 patients because microscopic examination revealed positive surgical margins. Eight patients underwent partial vertebrectomy and 1 patient had combined resection of the subclavian artery. There was no postoperative mortality. All patients received pre- or postoperative adjuvant therapy, or both. The overall 5-year survival rate was 31.0%. The 5-year survival rate was higher after complete resection than after incomplete resection (59.3% vs 0%, P = 0.08). Patients who underwent complete resection for vertebral invasion and those who did not had 5-year survival rates of 66.7% and 0%, respectively (P = 0.17). Patients who underwent preoperative induction therapy followed by complete resection and those who did not had 5-year survival rates of 80% and 0%, respectively (P = 0.009).

CONCLUSION

Although superior sulcus tumors are still complex, preoperative induction therapy followed by complete resection seemed effective for prolonging survival.

Video-assisted thoracic surgery for Ewing's sarcoma of the mediastinum in a 3-year-old girl

We report of the experience of video-assisted thoracic surgery (VATS) for a Ewing's sarcoma at the posterior mediastinum in a 3 year old girl. The patient developed common cold like symptoms and developed rapid lower limb paraplegia. A chest computed tomography (CT) showed a solid mass adjacent to the vertebrae. This was diagnosed as a Ewing's sarcoma histopathologically by CT-guided needle biopsy (CT-NB). The mass was pressing on a nerve root in the vicinity of a vertebral foramen. As the tumor reduced after induction chemotherapy, with improvement of paraplegia, the patient underwent thoracoscopic examination followed by complete removal of the tumor by VATS. After surgery, the patient underwent postoperative chemo-radiotherapy. Five years has passed after operation without tumor recurrence. VATS could be an option as combined therapy for Ewing's sarcoma when well controlled and localized under induction therapy.

Surgical treatment for lung cancer patients with poor pulmonary function

This retrospective study was aimed to review the risk factors of postoperative hospital death in lung cancer patients with poor pulmonary reserves. We performed surgery on 30 lung cancer patients (average age: 71 years) with less than 1.0L of preoperative forced expiratory volume in one second (FEV1.0 < 1.0L) between 1982 and 2003. The preoperative FEV1.0 of these 30 patients was 0.81+/-0.1L on average. Six of 20 patients who underwent surgery between 1982 and 1997 died during their postoperative hospital stay (hospital death group). Between 1998 and 2003, 10 patients underwent surgery with uneventful postoperative courses. The clinical background was evaluated between the hospital death group (n = 6) and the survivor group (n = 24). The single-variable analysis of the preoperative conditions of the postoperative hospital death revealed the presence of two or more preoperative concomitant diseases (p < 0.001) and a performance status of grade 2 or higher (p = 0.005). Peripheral obstructive pneumonia with abscess and chronic pleurisy with adhesion influenced surgery and related to their postoperative hospital death. Whereas, patients with chronic obstructive pulmonary diseases (COPD) tended to show that pulmonary resection resulted in an improvement of pulmonary functions.

CONCLUSION

To achieve better results of surgical treatment for patients with preoperative FEV1.0 < 1.0L, patient selection should be required based on precise evaluation of physical conditions and management of infectious diseases. Moreover, we thought that a preoperative performance status of grade 1 or lower, at most one preoperative concomitant disease, and a COPD are desirable for deciding the surgical indication.

Thoracoscopic Surgery in Children

PURPOSE

A minimally invasive thoracoscopic surgery offers several options in diagnosis and surgical treatment in the field of pediatric surgery. We would like to review our surgical experience and to assess the clinical outcomes and problems encountered during thoracoscopic surgery in children and adolescents focusing on children less than 6 years old.

PATIENTS AND METHODS

In 1992 and 2003, 977 patients underwent thoracoscopic surgery for chest diseases. Among them, from 1994 to 2003, 71 children and adolescents underwent thoracoscopic surgery. The thoracoscopic surgical procedures were classified into thoracoscopic surgery (TS) and video-assisted thoracic surgery (VATS). TS was performed through three or four trocar ports. VATS was performed through a small chest incision (minithoracotomy) with one or two trocar ports.

RESULTS

There was no morbidity or mortality associated with the thoracoscopic surgical procedures. None of the patients required a conversion to standard thoracotomy. The thoracoscopic surgical procedures were feasible in 71 children and adolescents with chest diseases including spontaneous pneumothorax, pulmonary nodules, diffuse pulmonary disease, pulmonary sequestration, and mediastinal tumors, and in those with palmar hyperhidrosis. TS was performed on two of five children with benign diseases including diffuse pulmonary disease and mediastinal bronchogenic cyst. VATS was performed on three children with pulmonary sequestration, lymphoid interstitial pneumonia and mediastinal Ewing's sarcoma. In one child with lymphoid interstitial pneumonia, the thoracoscopic surgery was converted to VATS because adhesion did not allow TS. The TS allowed rapid histological diagnosis and surgical treatment for benign pulmonary diseases and mediastinal cyst. Patients who were suffering from disease-related symptoms obtained complete relief with an uneventful postoperative course and quickly returned to their normal life. A boy who underwent lobectomy showed a normal growth rate for 4 years postoperatively. In the case of malignant chest diseases, the combination of chemotherapy and VATS was an effective treatment strategy.

CONCLUSIONS

We considered that the thoracoscopic approach is a rapid and simple method in the therapeutic diagnosis and surgical treatment of children and adolescents, even in children less than 6 years old. Cosmetic benefits were also obtained for girls. However, the most important consideration is the decision on a treatment strategy made by both pediatrician and thoracic surgeon.

Surgical treatment of lung cancer with vertebral invasion

Vertebral body invasion by lung cancer has been problematic due to uncertainty regarding a clear surgical resection margin. Therefore, additional chemoradiotherapy has been performed to assist clearance of the surgical margin. We reviewed our experience of surgical treatment for lung cancer patients with vertebral invasion. Between 1982 and 2003, 1,070 patients underwent lung cancer surgery at the Nippon Medical School Hospital. Eight patients (0.74%) of this group underwent a combined vertebral body and chemoradiotherapy. Seven lobectomies and one pneumonectomy with mediastinal lymphadenectomy were performed. All patients underwent partial vertebrectomy. The percentage with vertebral tumor involvement was 15%. A defect of vertebral cortical bone was reinforced with implantation of rib in one patient. There was no postoperative mortality. Postoperative complications were pneumonia and arrhythmia. The median follow-up period was 19 months (range from 4 to 69.7 months). The overall actuarial survivals at 1-year, 3-year and 5-year were 68.6%, 22.9% and 22.9%. Local recurrence occurred in three patients and distant metastasis was evident in five. Even though the number of patients was small, partial vertebrectomy with chemoradiotherapy offer reduction of severe pain and an improved prognosis. However, a patient with further progressive disease should be treated with a multidisciplinary approach.

Large anomalous systemic arterial supply to basal segments of the left lung

A 29-year-old man with a large anomalous systemic arterial supply to basal segments of the lower lobe was reported here. Pulmonary arteriography showed the absence of blood flow to basal segments. Aortography verified the anomalous artery from the descending thoracic aorta. Lobectomy was performed because the anastomosis between the anomalous and pulmonary arteries was anatomically difficult and segment 6 was small. The resected specimen showed that the anomalous artery had findings of pulmonary hypertension equivalent to grade V in the classification of Heath and Edwards. If the anastomosis between the anomalous and pulmonary arteries is anatomically feasible, pathological examination of open lung biopsy specimen is necessary to determine the operative procedures in this disease and two-staged operation is desirable.

Metastasis to the thyroid from lung adenocarcinoma mimicking thyroid carcinoma

We herein report a case of metastasis to the thyroid from lung adenocarcinoma mimicking thyroid carcinoma. The thyroid tumor was palpated in the left lobe of the thyroid and diagnosed as primary thyroid carcinoma by fine-needle aspiration cytology. The patient also had a large pulmonary tumor and tiny pulmonary nodules, which were respectively diagnosed as moderately differentiated adenocarcinoma of the lung and intrapulmonary metastases from the main large lung carcinoma by the pathological examination of the biopsy specimens obtained by video-assisted thoracic surgery. Hemithyroidectomy with radical neck dissection was performed. The thyroid tumor was diagnosed as metastasis to the thyroid from lung adenocarcinoma, because it showed mucin production, positive immunoreactivity for carcinoembryonic antigen and negative immunoreactivities for thyroglobulin and calcitonin. The patient received systemic chemotherapy and died of the disease 1 year and 7 months after the diagnosis was made.