Type A thymoma : a rare cause of neoplastic cardiac tamponade with long-term survival

Background: The prognosis of thymoma with cardiac tamponade is generally poor. Most of the reported thymomas with cardiac tamponade were type B or type AB (mixed thymoma), and cardiac tamponade due to type A thymoma, which has a better prognosis compared to type B thymoma, is extremely rare. Case presentation: We encountered a case of cardiac tamponade in a 71-year-old male. He visited our emergency department due to exacerbation of fatigue and dyspnea on exertion that lasted for two weeks. Chest imaging revealed a large amount of pericardial fluid and a contrast-enhanced tumor with calcification in the anterior mediastinum. The patient underwent thoracoscopic tumor biopsy and pathological examinations revealed type A thymoma. In this case, long-term disease-free survival (7.5 years) was achieved by multidisciplinary treatment (preoperative chemotherapy, surgical excision, and postoperative radiation therapy), in accordance with the histological type. Conclusions: This case indicates that neoplastic cardiac tamponade, even in elderly patients, should not necessarily be regarded as a terminal cancer and requires a systematic investigation for underlying causes

ダイドウミャク サシュキカンシ ニ シンジュン シタ コウド シンコウ キョウブ ショクドウガン ニ タイシ weekly DOC＋ low-dose FP リョウホウ ガ ソウコウシ コンチ セツジョ シエタ イチレイ

A ７０s woman was pointed out lower thoracic advanced esophageal squamous cell carcinoma with a chief complaint of dysphagia by upper gastrointestinal endoscopy. Computed tomography （CT）revealed that original tumor invaded to aorta and left main bronchus. Weekly docetaxel plus low-dose ５-FU and cisplatin therapy decreased the tumor. The invasion to aorta and left main bronchus was disappeared. She underwent curative esophagectomy. Main tumor had wide adherence to left main bronchus and aorta but was able to be resected. She underwent subtotal esophagectomy and gastric tube reconstruction by retrosternal route. Pathological diagnosis revealed carcinoma invaded from submucosa to adventitia and deep margin was negative（pT３）. Advanced esophageal carcinoma with invasion to aorta and main bronchus is commonly treated by definitive chemoradiotherapy and hardly undergo curative resection. This case underwent curative resection after only chemotherapy. This case suggests excellent anticancer effect of the triple drug therapy

Hypervascularized bronchial arteries affect lung cancer surgery

Background: The present study investigated whether highly vascularized bronchial arteries affect the intraoperative blood loss and the operative time of video-assisted thoracic surgery (VATS) lobectomy for patients with non-small cell lung cancer. Methods: We retrospectively collected data on consecutive pathological stage I to IIIA non-small cell lung cancer patients who underwent VATS lobectomy with systematic lymph node dissection between January 2017 and December 2019. Patients were divided into the following two groups according to bronchial artery diameters on preoperative enhanced contrast computed tomography (CT) findings: ≤2 and >2 mm groups. Results: Among the 175 patients enrolled, risk factors for intraoperative blood loss >50 mL were being male (P=0.005), a history of smoking (P=0.01), percent forced expiratory volume in 1 s (FEV1.0%) 2.0 mm (P2.0 mm (P200 min were being male (P2.0 mm (P2.0 mm (P=0.024), and experience of surgeon <10 years (P=0.047) in the multivariable analysis. Conclusions: Bronchial artery diameter was the most important risk factor of intraoperative bleeding and prolonged operative time during VATS lobectomy

マウスiPS細胞由来の気管支肺胞幹細胞は末梢気道上皮再生を促進する

Background: Bronchioalveolar stem cells (BASCs) located at the bronchioalveolar-duct junction (BADJ) are stem cells residing in alveoli and terminal bronchioles that can self-renew and differentiate into alveolar type (AT)-1 cells, AT-2 cells, club cells, and ciliated cells. Following terminal-bronchiole injury, BASCs increase in number and promote repair. However, whether BASCs can be differentiated from mouse-induced pluripotent stem cells (iPSCs) remains unreported, and the therapeutic potential of such cells is unclear. We therefore sought to differentiate BASCs from iPSCs and examine their potential for use in the treatment of epithelial injury in terminal bronchioles. Methods: BASCs were induced using a modified protocol for differentiating mouse iPSCs into AT-2 cells. Differentiated iPSCs were intratracheally transplanted into naphthalene-treated mice. The engraftment of BASCs into the BADJ and their subsequent ability to promote repair of injury to the airway epithelium were evaluated. Results: Flow cytometric analysis revealed that BASCs represented ~ 7% of the cells obtained. Additionally, ultrastructural analysis of these iPSC-derived BASCs via transmission electron microscopy showed that the cells containing secretory granules harboured microvilli, as well as small and immature lamellar body-like structures. When the differentiated iPSCs were intratracheally transplanted in naphthalene-induced airway epithelium injury, transplanted BASCs were found to be engrafted in the BADJ epithelium and alveolar spaces for 14 days after transplantation and to maintain the BASC phenotype. Notably, repair of the terminal-bronchiole epithelium was markedly promoted after transplantation of the differentiated iPSCs. Conclusions: Mouse iPSCs could be differentiated in vitro into cells that display a similar phenotype to BASCs. Given that the differentiated iPSCs promoted epithelial repair in the mouse model of naphthalene-induced airway epithelium injury, this method may serve as a basis for the development of treatments for terminal-bronchiole/alveolar-region disorders

CLE for visceral pleural invasion

Background: Visceral pleural invasion (VPI) in lung cancer is a significant prognostic factor; however, it is difficult to diagnose preoperatively or intraoperatively. In this study, we examined the possibility of intraoperative diagnosis of VPI using confocal laser endomicroscopy (CLE). Methods: Among patients with primary lung cancer who underwent surgery between April 2018 and August 2019, those in whom the tumor was in contact with the pleura on chest computed tomography and whose pleural changes were intraoperatively confirmed were enrolled in this study. In the 35 patients who underwent lung resection (6 cases with visceral pleural infiltration), the area where pleural change was noted was observed and a short video was recorded using CLE. Based on the video images, three evaluators determined the defect ratio (0%, 25%, 50%, 75%, and 100%) of the autofluorescence-positive structure. The area under the receiver operating characteristic curve was used to evaluate the diagnostic performance for VPI. In 15 cases (3 cases with VPI), a validation study was performed for intraoperative VPI according to the cutoff value of the defect ratio of the autofluorescence-positive structure. Results: The areas under the receiver operating characteristic curve for the defect ratio of the autofluorescence-positive structure were 0.86–0.91 for the three readers. Using defect ratio of autofluorescence-positive structure cutoff of ≥50% as predictor of VPI, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 83.3–100.0%, 57.7–73.1%, 35.3–41.7%, 95.0–100.0%, and 75.0–78.1%, respectively, for the three readers. In the validation study, the sensitivity was 100%, the specificity was 83.3%, and the diagnostic accuracy rate was 86.7%. Conclusions: The diagnosis of VPI through CLE is simple, non-invasive, and has high diagnostic accuracy rates. This method may be applicable for determining surgical procedures

ユウロウセイ ノウキョウ ニタイシテ EWS オ モチイタ キカンシ ジュウテンジュツ ト ロウコウナイ フィブリンコ チュウニュウ ノ ヘイヨウ ガユウコウ デアッタ 1レイ

Background : Empyema with a bronchial fistula is difficult to treat. Recently, bronchial occlusion using endobronchial Watanabe Spigot（EWS）ris reported to be useful for treatment of intractable pneumothorax and thoracic empyema. Case : A ６０ year old man presented fever and left chest pain. He was diagnosed with empyema. Video－ assisted thoracoscopic debridement and decortication for the empyema cavity and drainage for the abscess cavity were performed. Air leak appeared at postoperative day１３. We performed EWS embolization and intrapleural administration of fibrin glue, and the persistent air leak disappeared. Conclusion : We experienced empyema with a bronchial fistula successfully treated with EWS embolization and intrapleural administration of fibrin glue

キョウセン ヒテイケイテキ カルチノイド ノ 1セツジョレイ

Background. Thymic carcinoids are rare disease to account for ２-４％ of anterior mediastinal tumors. So, the clinicopathologic characters are not known enough. Case. A ６７ years old man was followed up old myocardial infarction, and he was taken chest CT scan for evaluate coronary artery. It revealed three anterior mediastinal tumors and we diagnosed thymoma by needle biopsy. We treated by neoadjuvant chemotherapy（CAMP therapy）, but it was ineffective. We performed thoracoscopic thymothymomectomy, and the pathological diagnosis was thymic atypical carcinoid. He is free of clinically event recurrence one year and a half after treatment. Conclusions. When we found an anterior mediastinal tumor, and if the clinical course is usually different, we should consider the possibility of a thymic carcinoid

ハイ アスペルギローマ ジュツゴ ハイロウ ニ タイシテ PushampSlideホウ ト ロープウェイホウ オ オウヨウ シタ EWS ニヨル キカンシ ジュウテンジュツ ガ ユウヨウ デアッタ 1レイ

Background : Bronchial occlusion using endobronchial Watanabe Spigot（EWS）is reported to be useful for treatment of secondary intractable pneumothorax and thoracic empyema, peripheral bronchial fistula. However, the methods of the bronchial occlusion are sometimes difficult and EWS sometimes fall off from plugged bronchus. Case : A ４４ year old man presented hemosputum. He was diagnosed with Aspergilloma. We performed a resection of the right upper lobe and S６ partial resection. Air leak appeared at postoperative day ３. We performed EWS embolization with an application of push & slide method and the ropeway method, and the persistent air leak disappeared. Conclusion : Our method is useful when the bronchial occlusion is difficult

シロリムス ヨウシュツ ステント リュウチ 7ネンゴ ニ ハジメテ ゾウエイザイ ステント シュウイ シミダシゾウ オ ミトメタ イチレイ

A 74-year-old man who had a history of percutaneous coronary intervention ［left anterior descending coronary artery ＃6‐7, sirolimus eluting stent （SES） （Cypher stent,3.0×18mm）, left circumflex coronary artery ＃13, SES （Cypher stent, 2.5×23mm）］ for angina pectoris experienced chest pain on effort after seven years from the coronary intervention. He was introduced to our hospital and coronary angiography revealed late acquired peri-stent contrast staining （PSS）, which is defined as an angiographical finding of contrast medium stain outside the stent being ＞20％ of the stent diameter, in the SES of the left anterior descending artery. Drug-eluting stent （DES） significantly inhibits neointimal proliferation, thereby significantly reducing in-stent restenosis. However, the risk of very late stent thrombosis has become a major problem after the DES implantation against the bare-metal stent implantation. PSS has been reported that PSS after SES implantation could predict late stent thrombosis and incomplete stent apposition of the lesion with PSS. In this case, PSS was pointed out for the first time in seven years after SES implantation nevertheless it did not be pointed out in three years. The mechanism and prognosis of PSS is unclear. But, we found the increase in local coagulation at the coronary artery in this case and the degree of prothrombin fragment F1＋2, one of the coagulation marker, was greater in seven years after SES implantation than in three years. We thought these findings might reflect that PSS after SES implantation was associated with very late stent thrombosis. So we started the dual antiplatelet therapy for the prevention of stent thrombosis. Careful long-term observation might be recommended in patients with late acquired PSS and elevated local coagulation response following SES implantation

ニンシン オ ケイキ ニ ジョウミャク ケッセンショウ オ ハッショウシ センテンセイ アンチトロンビンIII ケッソンショウ ト シンダン サレタ イチレイ

Congenital antithrombin III (AT III) deficiency is an inherited autosomal dominant disorder. Patients often suffer from recurrent venous thromboses that are triggered by several occasions (operation, gestation, trauma, oral contraceptive drug etc.). Moreover, 60% of them are said to be associated with pulmonary embolism. The patient of this report is 27-year-old pregnant woman in the first trimester. She felt pain in the back of her head and left auricle and presented with dyslexia and aphasia in late of March, 20XX. Getting CT brain scan, MRI brain scan, and blood sampling at the nearby hospital, she was suspected of having thrombosis of left sigmoid and transverse sinus due to AT III deficiency. Because she wanted to give birth to her first child without termination, she was referred to our hospital. We used heparin as the anticoagulant therapy because warfarin had the risk of teratogenesis. But in condition of low serum level of AT III activity, it didn’t work effectively. So we also did frequent complement of AT III. Strict anticoagulant therapy resulted in better outcome for both the patient and her baby without fatal venous thromboses or fetal complications