BACKGROUND/AIM Pleomorphic carcinoma (PC) of the lung is a rare tumor that usually has an aggressive clinical course and a poor prognosis. Clinical and pathological features remain unclear. The aim of this study was to determine whether tumor angiogenesis of PC is up-regulated compared to that in adenocarcinoma (AD). MATERIALS AND METHODS We collected 55 cases of PC and AD in which the patients had undergone either lung resection or autopsy and immunohistochemically examined the expression of vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF)-1α and microvessel density (MVD) in tissue specimens. RESULTS VEGF was expressed in many cases of both PC and AD with no significant differences between the groups. In contrast, the expression of HIF-1α and MVD were significantly greater in PC than AD. Median survival time of the PC group was 14.7 months and significantly shorter than that of the AD group. CONCLUSION MVD and expression of HIF-1α are associated with angiogenesis in PC and confer a poorer prognosis. Tumor angiogenesis provides significant prognostic information regarding clinical outcome in patients with PC.

背景．極めて稀な肺の良性上皮性腫瘍である，肺乳頭腺腫の1例を経験したため報告する．症例．16歳女性．健康診断にて胸部異常影を指摘された．胸部CT上左肺下葉に境界明瞭な3.4×3.2 cm大の腫瘤影を認めた．確定診断と治療目的に胸腔鏡併用左肺下葉切除術を施行した．腫瘍組織は核異型の乏しい円柱状の上皮細胞が線維血管性間質の周囲に乳頭状の増殖を呈しており，間質に弾性線維はみられなかった．免疫染色では上皮細胞はsurfactant apoprotein，pankeratin，epithelial membrane antigen，nuclear thyroid transcription factor-1に陽性を示し，Ki-67 labeling indexは4％以下であった．さらに電顕で細胞質にlamellar inclusion bodyを認めたことより，II型肺胞上皮細胞へ分化した肺乳頭腺腫と診断した．結論．極めて稀な肺の良性上皮性腫瘍である肺乳頭腺腫の1例を経験した．

A 69-year-old man was hospitalized for fever and cough. He was diagnosed with and treated for an abscess in the left lower jaw and pneumonia by an otolaryngologist, but the pneumonia persisted with no improvement. Chest computed tomography revealed the presence of a heterogeneous torose lesion in the inlet of the left upper bronchus, and bronchoscopy revealed an endobronchial tumor with a smooth surface. An episode of sudden dyspnea occurred and was resolved after the patient changed his sitting position. We concluded that this symptom occurred because the tumor was incarcerated in the left lower lobe bronchus. The tumor was excised by bronchofi berscopic snare resection under tracheal intubation. It was found to be a pleomorphic carcinoma, and left upper lobectomy was performed. There has been no recurrence during the 3 years since the operation.

縦隔悪性胚細胞性腫瘍（MGCT）の診断および治療アプローチを再確認するために，切除例の検討を行い，臨床上の問題点を明らかにした．対象は，1993～2006年に昭和大学関連3病院で切除したMGCT8例で，21～69歳，すべて男性．部位は前縦隔6例，中縦隔2例．AFP高値2例，HCG高値1例，両マーカーとも高値1例，上昇なし4例であった．組織検査は，CT下針生検4例，傍胸骨生検1例，縦隔鏡1例，未施行2例で，生検を行った6例中5例で，最終病理と一致した．初回治療は，化療4例（CR2例，PR2例），放治1例（NC），手術3例で，最終病理診断は，Seminoma3例，Yolk sac tumor1例，Adenocarcinoma with teratoma1例，Embryonal carcinoma1例，その他2例であった．MGCTの治療に際しては，化療の効果は良好であることからマーカー陽性例は速やかな抗癌剤治療が必要である．MGCTのなかに比較的高齢者，あるいは中縦隔発生例があることは留意すべき点である．

化生性胸腺腫（Metaplastic thymoma）は，多角細胞成分と紡錘形細胞成分が混在し，二相性を示す胸腺上皮性腫瘍であり，本邦での報告は少ない．症例は60歳代女性．検診の胸部X線検査にて，胸部異常影を指摘された．胸部CT，MRIで約6×4×3 cmの被包化した縦隔腫瘍を認め，胸腺腫，正岡病期分類I期と診断した．腫瘍随伴症状は認めず，抗Ach-R抗体は正常範囲内であった．また右S9に5 mmの結節病変を認めたことから，胸腔鏡併用による右小開胸下に縦隔腫瘍切除，また右S9部分切除を行った．肺の結節病変は肺内リンパ節であり，縦隔腫瘍は化生性胸腺腫であった．

After lung lobectomy, the residual thoracic cavity is filled by expansion of the remaining lobes and by mediastinal shifting. The mediastinal shift contributes to a change in the anatomical position of the heart. This change may affect electrocardiographic (ECG) findings but the relationship has not been examined. In this study, ECG intervals, including RR, P, PR, S-Tp, QRS, and QTc intervals, were analyzed before and after 86 lung lobectomies, consisting of 27 right upper (RU), 10 right middle (RM), 12 right lower (RL), 25 left upper (LU), and 12 left lower (LL) lobectomies. Persistent postoperative arrhythmia was observed in 10 patients (12%), all with atrial fibrillation. After RU lobectomies, the RR, PR, and S-Tp intervals became shorter. After RM lobectomies, the RR and QTc intervals became shorter and the P and PR intervals were prolonged. RL, LU, and LL lobectomies did not appreciably affect the ECG intervals. The post/pre-operative ratio of the P and PR intervals were greater following RM lobectomy than following RU or RL lobectomy. The post/pre-operative ratio of the QTc interval was smaller after RM lobectomy than after RL lobectomy. Lung lobectomy affected ECG intervals and the pattern of change varied depending on the lobe resected. Resection of the RM lobe, the lobe that is anatomically next to the right atrium, prolonged the PR interval and the change in pattern was different from RU or RL lobectomies. The change in the anatomical position of the heart following lung lobectomy may contribute to the changes in ECG intervals.

症例は66歳，女性。急性大動脈解離や胸腹部解離性大動脈瘤に対する二回の手術歴がある。二回とも気管切開は施行されていないが，二回目の術後に抜管ならびに経口挿管を三回繰り返されていた。二回目術後1カ月目に呼吸困難感ならびに喘鳴が出現し，当院へ緊急入院となった。気管支鏡では気管に全周性狭窄を認め，気管支鏡の通過は不可能であった。同狭窄部位は，CTにて胸部大血管三分岐再建術の吻合部に一致していた。よって気道狭窄に対する焼灼術は危険と判断，まず拡張用バルーンカテーテルにて狭窄部を拡張させ，細径経口挿管チューブを挿入，その後に気管切開をおき，細い経口挿管用のカフ無しチューブを気管切開部より挿入，狭窄部を通過させた。これにより呼吸困難感は消失し，歩行も食事も可能となった。段階的にチューブを太くしてゆくことにより，シリコンTチューブが挿入可能となり，退院となった。Tチューブ挿入から1年2カ月を経過して，安全に社会復帰を果たしている。本症例のような胸部大血管術後の気道狭窄に対して，バルーン拡張術や段階的にチューブを太くした上でTチューブを挿入することは安全な手法の1つと考えられた。

Gorham's disease is a rare disorder characterized by a non-malignant proliferation of thin-walled lymphatic vessels that result in progressive bony destruction and often extend into the surrounding soft tissues. Chylothorax is a common complication in cases of mediastinal involvement. Here we report a case of a 22-year-old male with Gorham's syndrome complicated by chyloma of the chest wall, but without chylothorax. To our knowledge, this is the first report demonstrating an abnormality of the parietal pleura prior to the clinical development of the chylothorax.

OBJECTIVE AND METHODS:In order to clarify the utility of video-assisted thoracoscopic surgery (VATS) for mediastinal disease, we analyzed retrospectively 34 thoracoscopic surgical cases (seven lymph node, nine thymic, eight cystic and 10 cases with solid lesions that excluded thymic diseases) between February 1993 and July 2002.RESULTS:In lymph node disease, adequate specimens were obtained in all cases; pathologic diagnoses were three sarcoidosis, two tuberculosis, and two other tumors. In thymic disease, all cases underwent thoracoscopic partial resection of the thymus. Conversion to thoracotomy or mediansternotomy was necessary in two cases of epithelial thymic tumors. In cases of cystic diseases, complete resections of the cysts were performed in five cases. Final diagnoses of these cysts were four bronchogenic, three pericardial, and one parathyroid cyst. In solid diseases, nine tumors were completely resected. Final diagnoses of these tumors were six neurogenic, and four other tumors.CONCLUSION:VATS is an effective and reliable approach for managing mediastinal diseases. Cases of small lesions surrounded by thymic tissue, cystic lesions excluding lymphatic duct origin, and neurogenic tumors without evidence of intraspinal invasion are good indications for VATS.

Recently, microwave coagulation therapy (MCT) is performed as minimal invasive treatment for liver tumor, and many studies concerning MCT have been reported. However, the clinical study focusing on the relationship between the accurate amount of microwave irradiation and surgical stress after MCT has not been reported. In this report, we studied the relation between the amount of microwave irradiation and the postoperative results in 30 cases who had been received laparotomic MCT. The amount of irradiation was correlated with the volume of necrosis and postoperative transaminase and LDH concentration. Abscess formation was observed in two cases who had been received high amount of irradiation. However, the amount of irradiation did not correlate to the postoperative hospitalization, the average of which is 21.0 ± 1.0 days in cases which received irradiation less than 160.0 × 103 J. The amount of irradiation would be the useful factor for estimating necrotic volume and surgical stress. Although a lot of irradiation might complicate abscess, it was suggested that MCT was safely executed in appropriate and enough amount of irradiation.