A case report of carotid body tumor

A case of left carotid body tumor is presented. A 47-year-old female patient consulted our otorhinolaryngological clinic with a neck swelling that had persisted for 5 months. On physical examination, a movable and pulsating hard mass measuring 2 x 2.5 cm in size was found on the left side of her neck, near the angle of the mandible. Computed tomography, magnetic resonance image and angiography all demonstrated a well-circumscribed tumor mass showing high vascularity and located at the bifurcation of the left carotid artery. The tumor involved the left carotid artery, but the patency of the artery was preserved. The patient showed satisfactory temporary balloon occlusion test results without neurological complications. Since the tumor was strongly adherent to the carotid arterial wall, the tumor was resected together with the carotid artery. Histologically, the tumor was composed of organoid clusters of round cells with eosinophilic granular cytoplasm. Involvement of tumor cells was seen to the adventitia of the carotid artery, but only slight cellular atypia was seen. Ultrastructurally, two types of cells were observed in the central and marginal portion of the tumor; these were round chief cells with few cytoplasmic neurosecretory granules and spindle-shaped sustentacular cells. Immunohistochemically, the chief cells and sustentacular cells showed positive reaction for neuron-specific enolase and S-100, respectively. The ultrastructural findings suggested the benign nature of the tumor.

[Imaged thoracoscopic surgery for bronchogenic cyst in posterior mediastinum--a case report]

A 44-year-old female with bronchogenic cyst in the posterior mediastinum was treated successfully by employing imaged thoracoscopic surgical methods in the same way as laparoscopic cholecystectomy. The patient was placed in the left lateral decubitus position. A first 3.5 cm skin incision was made in the seventh intercostal space on the mid-axillary line. A 10 mm, 0-degree Olympus wide angle telescope was inserted for observation into the thoracic cavity. And three more small skin incisions were done. A grasping forceps, a padron retractor and an electrode with J-hook tip were introduced through each incision. The cyst was completely dissected almost with the J-hook electrode. She was discharged on the 10th-postoperative day without complication and with minimal pain. We suggest that an indication of the imaged endoscopic surgery could be established for some benign mediastinal tumors.

[Two resected cases of malignant fibrous histiocytoma originated from the thoracic soft tissues]

Two resected cases, a 56-year-old man and a 49-year-old man, of malignant fibrous histiocytoma originated from the soft tissues of chest wall were reported. In both cases, MFH was histologically diagnosed prior to our radical operation. One patient received an incisional biopsy and the other was a recurrent case after excisional resection in other hospital. We resected the whole chest wall together with the tumor sufficiently apart from the tumor margin. In one patient the defect of chest wall was reconstructed with the material made of bone cement which sandwiched between 2 sheets of marlex heavy mesh and covered by latissimus dorsi muscle flap on it. The other was reconstructed with single sheet of marlex heavy mesh and covered by rectus abdominis muscle flap. Recurrence was not seen in either of two patients, in spite of the general acknowledgment that MFH recurs frequently and locally. We considered that the extended wide resection including the whole chest wall should be performed, and that marlex heavy mesh and the pedunculated musculo-cutaneous flap was useful for the reconstruction of chest wall defect.

[A case report of solitary bone cyst of rib detected from pathological fracture]

A case of solitary bone cyst of rib was reported. The patient was 28-year-old man who was admitted to our hospital complaining of chest pain caused by pathological fracture of the left 10th rib. Chest x-ray film revealed a solitary cystic lesion of the 10th rib. The tumor was removed by extrapleural rib partial resection and the histological examination confirmed the diagnosis of solitary bone cyst.