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We reported a case of intralobar pulmonary sequestration with a high level of the serum CEA. A 53-year-old woman whose chief complaint was cough was admitted to our hospital. Enhanced chest computed tomography (CT) revealed the mass in the left lower lung, lymph-nodes swelling, and the aberrant artery. Magnetic resonance angiography (MRA) conformed the aberrant artery from the descending aorta. The level of serum CEA elevated at 9.6 ng/ml. Left lower lobectomy was performed. A diagnosis of intralobar pulmonary sequestration (Pryce type II) was established in this case. Histopathologically, the peribronchial epithelial cells in pulmonary sequestration showed weak positive for anti-CEA monoclonal antibody. Postoperative course was uneventful and the serum CEA level was 3.5 ng/ml in the normal range at the postoperative 17th day.

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Pleomorphic carcinoma is a rare primary pulmonary malignancy. We report 2 surgical cases of pulmonary pleomorphic carcinoma. The first case was a 71-year-old male. Chest computed tomography (CT) showed a rapidly growing tumor with irregular density. Transbronchial lung biopsy revealed the tumor to be malignant. Left lower lobectomy was performed. Pathological diagnosis was pleomorphic carcinoma (pT2N2M0, stage IIIA). He died 8 months after surgery due to brain metastasis and mediastinal lymph node metastasis. The second case was a 74-year-old male who complained of bloody sputum. Chest CT showed a tumor with cavity in the right middle lobe. Brushing cytology under bronchofiberscopy revealed atypical cell. Right middle lobectomy and partial resection of the right lower lobe were performed. Pathological diagnosis was also pleomorphic carcinoma (pT2N0M0, stage IB). He has no findings of recurrence nor metastasis 15 months after the operation.

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We reported a case of mucoepidermoid carcinoma with a high level of the serum CEA. A 38-year-old woman was admitted because of abnormal chest shadow. Bronchoscopy revealed polypoid tumor occluding the lumen of right B3 bronchus. Bronchoscopic biopsy suggested a diagnosis of tubular adenocarcinoma. Chest computed tomography (CT) confirmed the mass in the right upper lung field and the swelling of right bronchial lymph node. The CEA level of serum elevated at 12.4 ng/ml. A right upper and middle lobectomy with mediastinal lymph nodes dissection was performed on August 26, 2003. Histopathologically, the polypoid tumor was a low grade mucoepidermoid carcinoma with partially extrabronchial extension. However, no lymph nodes metastasis were noted. The cytoplasms of about 45% of tumor cells showed positive for anti-CEA monoclonal antibody. Pathological stage was IB (T2N0M0). Seventeen months has passed with no evidence of recurrence and the CEA level of serum was in the normal range.

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We reported successful surgery for chronic hemorrhagic empyema with severe right heart insufficiency. The preoperative embolization of right internal thoracic artery and intercostals arteries was effective for the control of intraoperative bleeding. Non-invasive positive pressure ventilation (NIPPV) was useful for the perioperative respiratory management. A 62-year-old female with a history of right pneumonectomy and thoracoplasty for pulmonary tuberculosis was admitted because of dyspnea on effort on Dec 5th 2002. Her right heart insufficiency was worsened gradually. On May 20th 2003, we performed the transcatheter embolization of right internal thoracic and intercostals arteries for the control of intraoperative bleeding. The next day, the curettage and fenestration was performed for intraoperative cardiac dysfunction. The intraoperative bleeding was 1,596 ml and operative time was 2 hours 24 minutes. Due to CO2 narcosis, the ventilator under the intratracheal tube was needed for respiratory management in the postoperative course. The switching of the respiratory management with NIPPV from the intratracheal tube during 8 days, her respiratory and general conditions had been improved gradually. Because of methicillin-resistant Staphylococcus aureus (MRSA) infection of thoracic cavity, the radical thoracoplasty following the latissimus dorsi muscules flap and the omentopexy was performed. The operative course was uneventful and she needed overnight NIPPV without O2 inhalation and was discharged.

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The therapeutic results of liver transplantation for primary liver cancer have not been satisfactory. The high rate of recurrence appears to be due to the inadequate care taken in selecting the most appropriate candidates for orthotopic liver transplantation (OLT), the presence of circulating hepatocellular carcinoma (HCC) cells and micrometastases at the time of liver transplantation, and the tumor growth-promoting effects of immunosuppressive agents. We believe that HCC patients must be carefully staged in order to identify those most suitable for OLT. We therefore induced HCC in pure-strain rats by the oral administration of diethylnitrosamine (DEN) and studied the outcomes of liver transplantation at various time points (70, 120, and 134 days) after the initiation of carcinogenesis. The mean survival time (MST +/- SD) of the non-OLT control group (N = 14) was 18.2 +/- 5 days after Day 120. The survival time of the four rats in the OLT Day 120 group was 81.3 +/- 20.6 days after transplantation. One rat showing full weight recovery soon after transplantation survived for 97 days after transplantation and then succumbed to recurrence. The survival time of the four rats in the OLT Day 134 group was 7.3 +/- 5.0 days after transplantation. The survival time of the three rats in the OLT Day 70 group was 145.3 +/- 70.0 days after transplantation, with a maximum survival of 221 days until death. Significantly prolonged survival, as compared with that in the non-OLT group, was observed in the OLT Day 70 and OLT Day 120 groups (p < 0.01), while there was no significant prolongation in the OLT Day 134 group (NS). The timing of liver transplantation is a very important factor. Preoperative assessment of factors potentially affecting recurrence in HCC patients is imperative for selecting the most appropriate candidates for OLT. Careful selection of candidates for OLT should always be considered the key to successful liver transplantation (i.e., long-term survival) for patients with liver cancer.

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We report a case of papillary adenocarcinoma of the sigmoid colon with psammoma bodies and intracytoplasmic hyaline globules. The patient was a 59-year-old woman. The tumor showed central ulceration with smooth elevated ridges. Histologically, the tumor was composed of numerous large irregular tubular structures accompanying infolded papillary growth. The tumor cells showed cytoplasmic basophilia and prominent nuclear atypia. Psammomatous-type calcification was scattered in the tumor stroma as well as in the glandular lumina. In addition, intracytoplasmic hyaline globules of various sizes were seen in the neoplastic cells. We propose the name papillary adenocarcinoma associated with psammoma bodies and hyaline globules for this tumor. Accumulation of further cases is needed to clarify the clinical significance of this type of tumor.

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We report a case of adenocarcinoma of the rectum with foci of metaplastic shadow cells. The patient was a 65 year old man with anemia. Macroscopically the tumor was an ordinary rectal cancer. Microscopically, in addition to the features of moderately differentiated adenocarcinoma invading the subserosa, islands of shadow cells in tumor nests were detected in both primary and one of three pericolic metastatic lymph node lesions. Neoplastic glandular cells showed gradual transition to shadow cells. An antibody specific for high-molecular-weight cytokeratins reacted with the shadow cells and intermediate zone epithelial cells surrounding them, but no CEA, low-molecular-weight cytokeratins or cyclin D1 was detectable in them. Cytokeratin 14 was expressed only in the transitional zone epithelial cells. The intermediate zone epithelial cells were regarded as metaplastic squamous cells, from which the shadow cells were derived. The patient died of multiple liver metastases nine and a half months after surgery. To our knowledge, this is the first report of an immunohistochemical study of rectal adenocarcinoma containing shadow cells not only in the primary lesion but also in a metastatic lymph node.

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A 69-year-old man developed obstructive jaundice 6 months after laparoscopic cholecystectomy. Endoscopic retrograde cholangiography suggested a common bile duct (CD) stone. A second operation was performed, and this revealed a CBD stone with an endoclip as a nidus. Since laparoscopic surgery has become a very common procedure, endoclips are used more frequently. Therefore, careful surveillance and strict follow-up are stressed to avoid CBD stone and various other complications caused by endoclips.

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A 20-year-old man was admitted with a complaint of cough and dyspnea. Chest X-ray revealed a large anterior mediastinal tumor. On chest CT scan, the inferior vena cava was found to be enclosed, and tumor invasion to the right pulmonary artery and left atrium was observed. The serum alpha-fetoprotein (AFP) level was increased. A diagnosis of primary mediastinal embryonal carcinoma was made by the needle biopsy. After three courses of chemotherapy, consisting of cisplatin, etoposide and bleomycin, the tumor became smaller and the serum AFP level became normal. Complete resection of the tumor was performed successfully. The resected tumor showed no evidence of active disease. The patient has been free of the disease for 3 years.

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A 63-year-old man, who had undergone induction of artificial pneumothorax at 20 years of age as a treatment for right tuberculosis, developed fever and cough. A chest X-ray film showed marked pleural effusion in the right chest. Examination of sputum and the pleural effusion revealed tubercle bacillus, and right tuberculous empyema was diagnosed. At surgery, the right thoracic cavity was occupied by empyema, and multiple bronchopleural fistulae were observed. Because of the presence of tubercle bacilli in the empyema cavity, extraperiosteal air plombage thoracoplasty was insufficient for control of the empyema. Therefore, omentoplasty was added. Two months after the operation, the patient was discharged in good condition. He has been doing well without any sign of recurrence of empyema for the last two years. Although extraperiosteal air plombage thoracoplasty is a considerably effective therapy for empyema, its curability rate is lower in cases like the present one in which bronchopleural fistulae and bacteria are present in empyema cavity, such as our case. We consider that our method, extrapriosteal air plombage thoracoplasty with omentoplasty, is a reliable one for control of empyema, in patient with high risk factors for recurrence, such as bronchopleural fistulae and bacteria in the cavity.

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A case of mediastinal liposarcoma in a 45-year-old man is reported. The patient was admitted to the hospital complaining of rhinorrhea. A large mass was found in the right thorax by chest X-ray. At thoracotomy, a tumor measuring 11.5 X 9 X 8.5 cm located in the anterior mediastinum with an extension to the pleural cavity formed in right middle and lower lobes was found and removed from the adjacent visceral pleura. The tumor had a fibrous capsule and was multinodular in external appearance. The cut surface was yellowish and gelatinous. The histological diagnosis of myxoid liposarcoma was made according to the subclassification of liposarcoma proposed by Enzinger et al.

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In the present study, the first case of ruptured hepatoma followed by disseminated intravascular coagulation is reported. An elastase-like enzyme which possessed elastolytic and caseinolytic activities was confirmed from patient plasma. On the other hand, no elastase activity was detected in the plasma of patients with hepatitis, liver cirrhosis or hepatoma without disseminated intravascular coagulation. The patient plasma did not possess H-D-Val-Leu-Lys-p-nitroanilide hydrochloride, succinyl-L-alanyl-L-alanyl-p-nitroanilide, and pyro-Glu-Pro-Val-p-nitroanilide amidolytic activities. However, when chromatographed on Sephadex G-200, the presence of low-molecular weight plasminogen was confirmed. Its molecular weight was approximately 52,000. A slight decrease of alpha 2-plasmin inhibitor was noted, but no decrease of alpha 2-macroglobulin was detected.

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