was no history of trauma. A chest radiograph showed a left pleural effusion (fig 1). A plain computed tomographic (CT) scan showed a left pleural effusion with high density areas Abstract suspicious of blood. There was no evidence The case history is presented of a 61 year of an aneurysm. Numerous subcutaneous old man with von Recklinghausen's disease tumours were seen on the face, trunk, and who developed a spontaneous haemo-limbs. There were no abnormal neurological thorax. In spite of being asymptomatic findings although there was tachycardia for five days after drainage, he died as a (170/min) and the blood pressure was 120/ result of fatal sudden re-bleeding. The post 80 mm Hg. Atrial fibrillation was observed mortem examination showed dissection on the ECG and the haemoglobin level was and rupture of the left subclavian artery. 11.2 g/dl. Microscopically, disarrangement of An intercostal drainage tube was inserted and smooth muscle and decrease of elastic approximately 1000 ml of blood was removed. fibre was observed in the ruptured artery. After drainage the serous bloody discharge deHaemothorax in patients with von Reck-creased to below 100 ml per day. Radiologically linghausen's disease may require thora-there was no evidence of an increase in the cotomy, even if the condition of the patient pleural effusion. appears to be stable.Five days after admission he suddenly col- (Thorax 1997;52:577-578) lapsed and his blood pressure was unrecordable. Although cardiopulmonary resuscitation Keywords: haemothorax, von Recklinghausen's disease, was immediately performed, he died. Blood neurofibromatosis.did not flow out from the chest drainage tube. The chest radiograph taken two hours before cardiac arrest also showed no increase in the Von Recklinghausen's disease is transmitted by pleural effusion. an autosomal dominant gene and is charThe post mortem examination revealed acterised by multiple skin tumours and ab-about 4000 ml of blood in the thoracic cavity. normal cutaneous pigmentation. Benign The tumorous lesion with haematoma, about Department of schwannomas, osseous system involvement, 5 cm in diameter, in the apex was thought to five days after drainage but who died due to served at the ruptured portion. Neurofibromas sudden re-bleeding. The cause of arterial rup-were not seen at the ruptured portion. Hachioji Medicalture was different from those previously re-
We describe herein the successful surgical removal of an intrapulmonary aberrant needle. An asymptomatic 47-year-old woman underwent a routine chest X-ray which revealed a needle located in the right S8 area. We first tried to extract the needle; however, fluoroscopic examination confirmed that it had broken into two pieces and therefore, partial resection of the right S8 was performed. To avoid rethoracotomy, the operation was done under fluoroscopic guidance. An intrathoracic aberrant needle should always be removed surgically as soon as possible, even if the patient is asymptomatic, due to the possibility of its migration into the vessels and the development of lung abscess or pyothorax.
ObjectiveRecurrence at the bronchial stump frequently is difficult to diagnose before the disease progresses. Patients with recurrence at the bronchial stump after surgical treatment were studied to clarify characteristics. Summary Background DataReports on this type of recurrence are few. MethodsBetween January 1979 and December 1988, 625 primary lung cancers were resected. Fourteen patients (2.2%), in whom recurrence occurred at the bronchial stump, were studied pathologically and clinically. ResultsEight tumors (57.1 %) were squamous cell carcinomas, five (35.7%) were adenocarcinomas, and one (7.1 %) was small cell carcinoma. Pathologically, six tumors (42.9%) were stage 1, four (28.6%) were stage 11, two (14.3%) were stage "IA, and two (14.3%) were stage IV. Eight patients had bloody sputum at recurrence; two cases were asymptomatic. Submucosal tumors were observed bronchoscopically at recurrence in 11 patients. Considering lymphadenopathy on chest x-ray, the submucosal type recurrence may have been direct invasion from metastatic lymph nodes. The periods from the operation to the recurrence were 7 to 102 months (mean 28.8 months). In 8 of 14 patients, recurrence was observed within 24 months. All but one patient died within 24 months of recurrence detection. ConclusionsLong survival could be expected only if there were no metastases in the mediastinal lymph nodes.If the tumors were detected earlier, it was possible to cure the tumors by intensive therapy, even in submucosal type recurrence. Regular bronchoscopic examination is needed to diagnose the recurrence at the bronchial stump as early as possible.
Squamous cell carcinoma of the breast is a rare type of cancer, the origin of which is still uncertain. We report a case of squamous cell carcinoma of the breast with a recurrent tumor that showed undifferentiated features. The patient was a 55-year-old woman who originally presented with a left breast mass in the upper outer quadrant. Echography showed a 46 x 29 x 23-mm mass with cavity formation, and aspiration cytology confirmed a diagnosis of squamous cell carcinoma. A modified radical mastectomy with level III lymph node dissection was performed. Pathologically, the tumor was composed of squamous cell carcinoma and noninvasive ductal carcinoma. A recurrent tumor showing undifferentiated features was detected in the left forechest 3 months after the operation, and tumorectomy with partial resection of the major and minor pectoralis muscles was performed. Despite intensive therapy including chemotherapy (CEF: cyclophosphamide, epirubicin, 5-fluorouracil) and irradiation (50 Gy), the patient died from pulmonary and skin metastases 20 months after her initial operation. The squamous cell carcinoma of the breast in this patient grew rapidly and her prognosis was poor. Immunohistochemical findings indicated the possibility that the squamous cell carcinoma developed from noninvasive ductal carcinoma of the comedo type, and that the undifferentiated cells from the site of recurrence developed from dedifferentiation of the squamous cell carcinoma.
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