A 44-year-old woman was found to have an abnormal shadow on a chest X-ray during a regular health checkup, and visited our department. Chest computed tomography showed multiple nodular shadows in both lungs. The patient had no history of neoplasm except for myomectomy for uterine leiomyoma 6 years previously. Eighteen months later, the nodules showed a gradual increase in size, and video-assisted thoracoscopic biopsy of a nodule was performed. Histopathologically, the pulmonary nodule was composed of benign smooth muscle cells proliferating in fascicles, consistent with the diagnosis of benign metastasizing leiomyoma. Benign metastasizing leiomyoma is defined as a histologically benign uterine smooth muscle tumor that acts in a somewhat malignant fashion and produces benign metastases. Although it is a rare condition, it should be considered in asymptomatic women of reproductive age with a history of uterine leiomyoma, who present with solitary or multiple pulmonary nodules. Herein, we report a case of pulmonary benign metastasizing leiomyoma.

BackgroundCases of recurrent inflammatory pseudotumor have only rarely been reported. The treatment for recurrent pseudotumor is surgery. Patients not eligible for surgery require different treatment, and the optimal type of the treatment is controversial.Case PresentationA 54-year-old woman was noted to have an abnormal shadow in the right middle lung field on chest X-ray. Computed tomography of the chest revealed an infiltrative lesion in the right segment 4 and a nodule in the right segment 8. She underwent right middle lobectomy and partial resection of the right segment 8. Histopathology revealed non-atypical lymphocytes and plasma cells infiltrates, leading to the diagnosis of the lymphoplasmacytic type of inflammatory pseudotumor. During postoperative follow-up, chest computed tomography revealed a nodular lesion in the left segment 3 and an infiltrative lesion in the right segment 2. Left segment 3 segmentectomy and right segment 2 wedge resection were performed. The histopathological findings were similar to those of the first surgical specimen, leading to the diagnosis of recurrent lymphoplasmacytic type of inflammatory pseudotumor.ConclusionSurgical cases of recurrent inflammatory pseudotumor of the lung have been reported only very rarely. We believe that surgery is the best treatment for recurrent inflammatory pseudotumor of the lung when patients are eligible.

Pleomorphic adenoma usually occurs in the salivary glands but rarely in the trachea or bronchi. A 71-year-old man had abnormal shadows on a chest X-ray. Chest CT revealed one tumor in the right basal segment of the lung and another, in the left main bronchus. Bronchoscopic biopsy of the right tumor revealed well-differentiated squamous cell carcinoma. Right lower lobectomy and lymph node dissection were performed (pT2N0M0, stage IB). At the orifice of the left main bronchus, bronchoscopy identified a polypoid lesion nearly obstructing the airway. The lesion was resected with hot snare ablation. The histological examination revealed a mixture of epithelial and myxoid mesenchymal elements, characterized by ductal structures, squamous metaplasia, and cartilage tissue. The diagnosis was bronchial pleomorphic adenoma coexisting with squamous cell carcinoma of the lung.

Pulmonary metastasis from carcinoma of the papilla of Vater is considered to be a late event, and patients can be treated with radiotherapy, chemotherapy, or palliative surgery. However, surgical treatment of an isolated lung metastasis has not been reported. We present a surgical case of solitary pulmonary metastasis from carcinoma of the papilla of Vater. A 51-yearold man underwent pylorus-preserving pancreaticoduodenectomy for Vater carcinoma. During follow-up, chest computed tomography revealed a nodular shadow in the right lung. The pathological examination demonstrated the appearance of the pulmonary tumor resembled that of the previously resected Vater carcinoma, and both tumors showed similar immunostaining properties, leading to the pathological diagnosis of pulmonary metastasis from carcinoma of the papilla of Vater. Isolated pulmonary metastasis from carcinoma of the papilla of Vater is extremely rare, but surgery could be the treatment of choice.

A 78-year-old man underwent right lower lobectomy for lung cancer. Histopathological examination led to the diagnosis of adenosquamous cell carcinoma. The background lung adjacent to the pleura showed idiopathic pulmonary fibrosis of microscopic usual interstitial pneumonia pattern, although preoperative computed tomography showed no apparent findings of interstitial pneumonia. The patient showed an acute exacerbation of idiopathic pulmonary fibrosis on the third postoperative day. We herein report a case of acute exacerbation of idiopathic pulmonary fibrosis of microscopic usual interstitial pneumonia pattern after lung cancer surgery.

BackgroundDifferent types of vascular proliferation may occur in lymph nodes, but hemangiomas in lymph nodes are extremely rare.Case PresentationA 73-year-old man was found to have a 15-mm nodular shadow in the left lung on computed tomography, and bronchoscopic brush cytology yielded a diagnosis of squamous cell carcinoma. Chest computed tomography showed no evidence of hilar or mediastinal lymphadenopathy. Left lower lobectomy with hilar and mediastinal lymph node dissection was performed. Postoperative histopathological examination revealed squamous cell carcinoma and no lymph node metastasis. On the other hand, a lobar bronchial lymph node presented a small lesion showing the dense proliferation of capillary blood vessels with elastic change. Immunohistochemically, the lesion was positive for factor VIII and CD34, leading to a diagnosis of primary hemangioma of the lymph node.ConclusionTo our knowledge, this is the first case reported in the literature of hemangioma in a pulmonary hilar lymph node. Intranodal hemangioma needs to be differentiated from malignant vascular tumors.

Hepatic hydrothorax in the absence of ascites is a rare complication of liver cirrhosis. A 71-year-old man with liver cirrhosis due to alcohol abuse was referred to our department because of massive pleural effusion on the right side. The properties of pleural effusion and clinical course led to a diagnosis of hepatic hydrothorax. Nonsurgical OK-432 pleurodesis resulted in a marked decrease of pleural effusion. After 2 months of follow-up, effusion was well-controlled. Patients with hepatic hydrothoraces have few options. OK-432 pleurodesis is relatively safe and may provide an effective alternative to peritoneovenous shunt, transjugular intrahepatic portosystemic shunt or surgical pleurodesis. It may also be a bridge toward liver transplantation in patients with few other options. Herein, we report a case of refractory hepatic hydrothorax successfully treated by nonsurgical OK-432 pleurodesis.

T tube insertion for subglottic stenosis is often difficult due to bending of the T tube itself. A T tube could be inserted safely and consistently in a patient with severe subglottic stenosis employing a method that we newly devised. Our method can be performed under local anesthesia without special instruments and is technically straightforward. And also, our method is considered to be applicable to marked stenosis and stenosis with a complex morphology. Herein we present an improved method for inserting a silicone T tube through a tracheostomy stoma in patients with severe subglottic stenosis.