Unknown primary large cell neuroendocrine carcinoma (LCNEC) in the mediastinum is extremely rare. In this report, we present a case of a 53-year-old man with superior vena cava (SVC) syndrome who developed LCNEC in the middle mediastinum. His chief complaint was facial edema. Chest X-ray revealed an abnormal shadow in the right upper mediastinum. Computed tomography (CT) scan of the chest revealed a 67-mm mass in the middle mediastinum. Tumor invasion caused constriction of the SVC. The patient underwent induction chemoradiotherapy with vinorelbin and cisplatin and concurrent radiation therapy. After induction therapy, the tumor size decreased remarkably and was resected completely. The pathological diagnosis was LCNEC.
Patients with severe emphysema have a higher risk of developing lung cancer, and their surgical risk increases when emphysema is accompanied by a giant bulla. Here, we describe a patient who had an emphy-sematous giant bulla in the right upper lobe that was treated with an endobronchial valve placement. Subsequently, a cancerous lesion on the contralateral lung was successfully removed by lobectomy. A 50-year-old man was admitted because of a left upper lobe mass. He was a current smoker with a 35 pack-year smoking history and a clinical history of pulmonary tuberculosis that had been diagnosed and treated 15 yeas ago. A chest computed tomography scan showed a 51-mm mass in the left upper lobe, which was strongly suggestive of lung cancer. Both of the upper lobes exhibited emphysematous changes. A giant bulla was observed in the right upper lobe, and it was large enough to fill the right upper lung zone (Fig. 1). His lung function was not a contra-indication to lobectomy, with a forced expiratory volume in 1 second (FEV 1) of 2.21 (62% of predicted), a functional volume capacity (FVC) of 3.78 L (84% of predicted), and a diffusing capacity of the lung for carbon monoxide of 67% of predicted. However, we determined that it would be too dangerous to perform one-lung ventilation surgery while leaving the giant bulla intact in the right upper lobe, so we placed an endobronchial valve (EBV) into the right upper lobar bronchus to eliminate the bullous lesion. EBV placement was carried out under rigid bron-choscopy using the standard procedure described by Dumon [1]. Briefly, endotracheal intubation was performed using a rigid bronchoscope tube (Hopkins; Karl-Storz, Tuttlingen, Germany) under general anesthesia that was induced by intravenous propofol. Then, the initial exploration of the tracheobronchial tree was followed by a Flexible bronchoscope (EVIS BF 1T240; Olympus, Tokyo, Japan) through a rigid bronchoscope tube. After identification of the right upper lobe bronchus, three Zephyr EBVs (Pulmonx, Korean J Thorac Cardiovasc Surg 2017;50:305-307 □ CASE REPORT □ https://doi.
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