Geochronology of faults

13301乙第2145号博士（理学）金沢大

Geochronology of faults

13301乙第2145号博士（理学）金沢大

A case of primary breast cancer with chronic phase chronic myelogenous leukemia

A female patient in her ４０s was admitted because of right breast swelling and pain. She had been taking Nilotinib（a molecular targeted drug）for ４months as treatment for chronic-phase chronic myelogenous leukemia. She was diagnosed with advanced breast cancer by cytology and histological examinations. She received neoadjuvant chemotherapy and had obtained a partial response. She then underwent a nipple-sparing mastectomy and axillary lymph node dissection. Therefore, in this patient, breast cancer and chronic myelogenous leukemia coexisted. Chemotherapy for breast cancer and a molecular targeted drug for chronic-phase chronic myelogenous leukemia were administered concurrently

術後肺ヘルニアに対し，緊急修復手術を施行した１症例

A male patient, in his ５０s, was admitted owing to rear neck pain and stomachache. He was diagnosed Type A acute aortic dissection and underwent a total arch aortic replacement operation. Five days later, he developed dyspnea after he coughed. He was diagnosed left lung hernia, mediastinal emphysema and pneumothorax by a chest CT scan. We repaired pulmonaly fistula and lung hernia using an ePTFE patch

甲状腺癌リンパ節転移との鑑別が困難であった頸部神経鞘腫の１例

A female patient in her 60s visited her previous doctor because of a right cervical mass that exist for 7 years and gradually increased in size. As she was suspected of cervical lymph node metastasis of thyroid cancer, she was referred to our hospital. At the initial visit, a 5-cm right cervical mass and enlargement of the right lobe of the thyroid gland were observed. Fine needle aspiration cytology was performed on both, but no malignant findings were observed. To confirm the diagnosis and improve the patient’s appearance, a right lobectomy of the thyroid gland and resection of the right cervical mass were performed. A rapid intraoperative histological examination of the cervical mass revealed a schwannoma. The right thyroid tumor was diagnosed as follicular adenoma. Her postoperative course was good, and after several years of follow-up, patient consultation was terminated. Neurolemmoma is a benign tumor arising from Schwann cells in the nerve sheath, and it occurs frequently throughout the head and neck region, with 25%-45% of cases occurring in this region. Cervical schwannomas are characterized by irritation of the vagus nerve, brachial plexus, and sympathetic nerves. However, many patients present with only a painless neck mass, as in this case. Although the mass can be diagnosed by puncture aspiration cytology in some cases, sufficient specimens are often unavailable, and the diagnosis is made preoperatively in about half of all cases. Differential diagnoses of an anterior cervical mass include malignant lymphoma, cervical lymph node metastases of malignant tumors, submandibular gland tumors, and tuberculous lymph node metastases. In this patient, we also considered lymph node metastasis of thyroid cancer. However, a histological examination did not detect malignancy in either the thyroid gland or neck mass, and we considered that the thyroid follicular adenoma and the cervical schwannoma occurred independently. We report our experience of cervical schwannoma combined with thyroid tumor which was suspected of lymph node metastasis of thyroid cancer

Two cases of pulmonary dirofilariasis

Pulmonary dirofilariasis is almost always asymptomatic. An abnormal nodule was accidentally discovered by a chest x-ray during a medical checkup and detailed examination for other diseases was performed. Case １. A female patient, in her ７０s, was admitted owing to flu-like symptoms and bloody sputum. A chest computed tomography（CT）scan revealed a nodular shadow with １０‐mm ground glass opacity in the right lower lobe. Case２. A female patient, in her ６０s, was admitted due to an abnormal shadow on a chest xray in the left lung during a regular medical checkup. A chest CT scan revealed a nodular shadow with １３‐mm ground glass opacity in the left upper lobe. Lung cancer was suspected in both cases. Thoracoscopy and partial lung resection were performed to confirm the diagnosis. The specimen consisted of granulation tissue and no malignancy was found at operation. Final pathological diagnosis revealed pulmonary dirofilariasis. Pulmonary dirofilariasis can be definitively diagnosed by detecting a worm body. We believe partial lung resection during video-assisted thoracic surgery is a minimally invasive and an effective treatment for this disease

AYA-generation lung cancer in a patient presenting with spontaneous pneumothorax : A case report

Background : Surgery for young patients（i.e., <２０ years of age）with early-stage lung cancer is extremely rare. To the best of our knowledge, only a few cases of lung cancer initially presented with spontaneous pneumothorax. Here, we report a case of AYA（adolescent and young adult）-generation lung cancer in a patient who presented with spontaneous pneumothorax. Case : An １８-year-old male was admitted to our hospital for new-onset left pneumothorax. Chest computed tomography incidentally revealed a pure ground-glass nodule（pGGN）in the left lower lobe（S８）with a bulla near the nodule. While chest tube drainage improved his condition, pneumothorax recurred two weeks later, prompting surgical for video-assisted partial resection of the left lung. Intraoperative findings showed that the bulla and nodule were distant. Histopathologic analysis was consistent with a diagnosis of adenocarcinoma in situ with a bleb. Conclusion : This study highlights the importance of considering the possibility of lung cancer in patients with irregular chest shadows, even those less than２０years of age. Computed tomography plays an important role in the diagnosis of lung cancer in patients with spontaneous pneumothorax

若年性乳腺線維腺腫

A １２-year-old, premenarchal girl with a rapidly growing breast lump was transferred to our hospital. Ultrasonography revealed a ７．９×７．７×３．３cm large well-circumscribed hypoechoic tumor in the medial region of her right breast. After ２ months of this first visit, the breast lump had enlarged to１０ cm in diameter and was consequently subjected to a wide excision. Size of the tumor was９．５×９．２×３．０cm. Histopathological diagnosis was fibroadenoma without any malignant component. One year after the operation, a new lump with a diameter of４cm was detected in the lateral region of her right breast that had a similar appearance of the previous tumor. The tumor was excised as earlier and diagnosed as fibroadenoma. We present an extremely rare case of a rapidly growing breast fibroadenoma in a premenarchal girl. To the best of our knowledge, there were only ２１ cases reported in Japan. Since the patient is concerned that another asynchronous fibroadenoma might occur, she needs a long-term and careful follow-up

キョウクウキョウカ ニ セツジョ シタ ジュウカクナイ イショセイ フクコウジョウセン センシュ

A woman in her ６０s who was diagnosed as having hypercalcemia and hyperparathyroidism was referred to our hospital. Serum calcium and intact parathyroid hormone levels were１１．４mg/ ml and １０７ pg/ml, respectively. Chest computed tomography revealed an enhanced mass measuring approximately１．５cm located in the anterior mediastinum. ９９mTc-Methoxy-isobutylisonitrile scintigraphy demonstrated an anterior mediastinal mass. These findings suggested an ectopic parathyroid tumor located in the mediastinum. The patient underwent resection of the parathyroid tumor with video-assisted thoracic surgery（VATS）. The operation time was １１４ min. The postoperative day１（POD１）calcium level rapidly decreased to８．３mg/ml. The patient was discharged on POD５, and there have been no signs of recurrence １ year after the surgery. Parathyroidectomy by VATS for ectopic mediastinal parathyroid tumors is advantageous because it is less invasive and more cosmetic. VATS may be used as a standard approach for ectopic mediastinal parathyroid tumors. We report the surgical treatment of a case of ectopic mediastinal parathyroid adenoma using video-assisted thoracoscope

中毒性多結節性甲状腺腫

A woman in her 80s who was diagnosed with multiple thyroid tumors and subclinical hyperthyroidism 1 year previously was referred to our outpatient clinic due to deteriorated hyperthyroidism. She was diagnosed with dilated cardiomyopathy 4 years ago. Her cardiac function has been stabilized with medical conservative treatment. Blood autoantibody levels, including TSAb and TRAb, were within normal ranges. Ultrasonography and computed tomography revealed multiple tumor lesions in both thyroid lobes. Tc-99m scintigraphy showed multiple hot nodules in both thyroid lobes. Because the patient’s thyroid function had deteriorated, we selected surgical total thyroidectomy rather than radioisotope treatment as the most appropriate treatment. Histopathological examination of the resected specimen demonstrated multiple nodular lesions with a maximum size of 23 mm and a microlesion of papillary carcinoma 2 mm in diameter in the thyroid. A few days after surgery, thyroid function blood levels declined to the normal range