Placental transmogrification of the lung (PTL) is a very rare benign lung lesion. There are only about 40 cases reported in the literature. The imaging and histological features of PTL cases in the publication are various, most of which are cystic and a few of which are solid. Being extremely rare, the solid PTL is unknown to major pathologists and surgeons. We reported a case of solid PTL in the anterior mediastinum. The patient was a 52-year-old male with no history of smoking and without symptoms. During physical examination, chest CT revealed a circular low-density lesion with a maximum diameter of 2.9 cm beside the spine in the posterior basal segment of the left lower lobe of the lung. The wedge resection was performed by video-assisted thoracoscopy. Grossly, a round nodule was located underneath the visceral pleura. It was about 3.0 cm×3.0 cm×1.6 cm and the cut surface was grey-red, soft and spongy. Microscopically, the nodule was constituted of papillare, which resembled placental villi at low magnification. The axis of papillae was edema, in which some mild round cells with clear cytoplasm and CD10 positive staining aggregated and transitioned to immature adipocytes and amorphous pink materials deposited with a few of inflammatory cells infiltration. The surface of papillae was covered with disconti-nuous alveolar epithelium. Combined with the typical morphology and immunohistochemical characteristics of CD10 positive, the diagnosis was PTL. The patient was followed up for 1 year without recurrence and discomfort. So far, the pathogenesis of PTL is unclear. The major hypotheses include hamartoma, variant of emphysema and clonal hyperplasia of stromal cells. Based on the study of our case and publication, we speculate that the hyperplasia of stromal cells located in the alveolar septa might be the first step to form the solid PTL. With the progression of the disease, a typical unilateral cystic nodule develops as a result of secondary cystic degeneration due to the occlusive valve effect. Surgery is the only option for diagnosis and treatment of PTL. The clinician should make an individualized operation plan according to the clinical manifestations, location and scope of the lesion, and preserve the surrounding normal lung tissue as much as possible while completely removing the lesion. There is a favorable prognosis.
Male ; Humans ; Female ; Pregnancy ; Middle Aged ; Hyperplasia/pathology* ; Placenta/pathology* ; Lung/pathology* ; Pulmonary Emphysema/surgery* ; Tomography, X-Ray Computed/methods*

Lung volume reduction loop uses bronchoscopic lung volume reduction(BLVR) technology to compress and collapse the necrotic emphysema tissue and exhaust the internal gas to achieve the purpose of lung volume reduction to treat emphysema. After the lung volume reduction loop is implanted into the human body, the compressed part of the lung tissue tends to expand with breathing, which makes the lung volume reduction loop expand into a linear trend periodically. Fatigue resistance is one of the most important performance indexes of the lung volume reduction loop. In the paper, Z-direction vibration fatigue machine was used to simulate the changes of human respiratory cycle movement to test the fatigue performance of lung volume reduction loop, which can provide some reference for the test method of in vitro fatigue performance of lung volume reduction related products in the future.
Bronchoscopy/methods* ; Emphysema/surgery* ; Humans ; Lung ; Pneumonectomy/methods* ; Pulmonary Emphysema/surgery* ; Treatment Outcome

Humans ; Pilot Projects ; Prospective Studies ; Pulmonary Emphysema/surgery* ; Lung/surgery* ; Emphysema ; Perfusion ; Tomography, Emission-Computed ; Tomography ; Tomography, Emission-Computed, Single-Photon ; Pneumonectomy ; Bronchoscopy/methods*

Although many patients with severe emphysema have benefited from bronchoscopic lung volume reduction (BLVR) worldwide, experience of BLVR in Asian emphysema patients is scarce. Between July 2012 and March 2013, seven patients with advanced heterogeneous emphysema underwent BLVR in the Asan Medical Center. They had severe dyspnea and poor lung function (Modified Medical Research Council dyspnea scale 3-4; median forced expiratory volume in 1 sec [FEV1], 0.59 L [19.0 % predicted]; median 6-min walk distance [6MWD], 195 m). Endobronchial valves were inserted into the target lobe which was most hyperinflated and least perfused, and had no collateral ventilation with other lobes. Six patients showed clinical improvement after 1 month. Of them, 2 patients improved to dyspnea scale 1 and 4 patients did to scale 2 (P = 0.026). The median FEV1 increased from 0.59 to 0.89 L (51%; P = 0.028) and the median 6MWD increased from 195 to 252 m (29.2%; P = 0.028). Two patients developed a pneumothorax (one requiring drainage) and one patient experienced slight hemoptysis; however, there were no other serious adverse events. BLVR is effective in Asian advanced emphysema patients, with noted clinical improvements in lung function and exercise capacity.
Aged ; Asian Continental Ancestry Group ; Bronchoscopy/*methods ; Forced Expiratory Volume ; Humans ; Lung/pathology/surgery ; Male ; Middle Aged ; Pneumonectomy/*methods ; Pulmonary Emphysema/*surgery ; Severity of Illness Index ; Tomography, X-Ray Computed ; Treatment Outcome

Giant bullae are large bullae occupying at least one-third of the hemithorax and surgical bullectomy is the treatment of choice. We report a case with symptomatic giant bullae which were resected successfully. A 35-year-old man presented with bilateral giant bullae that occupied almost the entire left hemithorax and a third of the right hemithorax. He was a current smoker with a 30 pack-year history and he presented with dyspnea on exertion. An elective surgical bullectomy was performed with video-assisted thoracoscopic surgery. The patient recovered without any adverse events and stayed well for 1 month after surgery.
Adult ; Blister ; Dyspnea ; Humans ; Pulmonary Emphysema ; Thoracic Surgery, Video-Assisted ; Young Adult*

BACKGROUNDIf the emphysema lesions are not symmetrical, unilateral lung volume reduction surgery (LVRS) can be carried out on the more severe side. The aim of this research was to evaluate the feasibility and effects of LVRS performed simultaneously with resection of pulmonary and esophageal neoplasms.

METHODSForty-five patients with pulmonary neoplasm and 37 patients with esophageal neoplasm were randomly assigned to group A or group B. In group A, LVRS was performed simultaneously on the same side as thoracotomy. In group B, only tumor resection was performed. The nonfunctional lung area was determined by preoperative chest computed tomography and lung ventilation/perfusion scan. The lung volume removed was about 20% to 30% of the lobes on one side. Preoperative and postoperative indexes including pulmonary function testing variables, arterial blood gas analysis variables, dyspnea scale, 6-minute walk distance, etc., were compared between the groups.

RESULTSThere were no surgical deaths in this study. The postoperative forced vital capacity in 1 second, PaO2, PaCO2, dyspnea scale, and 6-minute walk distance were improved significantly in group A, whereas these indexes did not change or decreased slightly in group B.

CONCLUSIONSFor tumor patients who have associated emphysema, simultaneous LVRS not only increases the chance of receiving surgical therapy, but also improves the postoperative quality of life of the patient. LVRS has expanded the surgical indication for tumor patients.

Adult ; Esophageal Neoplasms ; surgery ; Female ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Pneumonectomy ; methods ; Pulmonary Emphysema ; surgery ; Thoracotomy ; methods ; Treatment Outcome

OBJECTIVETo review the experience with the management of single lung transplantation for emphysema.

METHODSBetween January 2003 and August 2006, single lung transplantation was performed in 6 patients for emphysema with cold low potassium solution flushing. A triple-drug regimen was adopted using steroids, mycophenolate mofetil and tacrolimus as the maintenance immunosuppressants. Chest radiograph score, oxygenation index, and pulmonary arterial pressure of the patients in early after the transplantation were reviewed.

RESULTSAll the 6 patients survived for over 30 days after the operation, and 4 of them remained alive with good quality-of-life. Four patients recovered from acute rejection successfully after methylprednisolone pulse therapy for 3 days. One patient underwent reoperation for hemorrhage in the thoracic cavity and finally recovered; spontaneous pneumothorax of the autologous lungs occurred in two patients, who underwent reoperation but finally died 74 days and 77 days after the transplantation, respectively.

CONCLUSIONSingle lung transplantation is effective for end-stage emphysema. Carefully selected recipients and comprehensive design of the surgical procedures are critical to successful lung transplantation.

Adult ; Female ; Humans ; Lung Transplantation ; methods ; Middle Aged ; Pulmonary Emphysema ; surgery ; Treatment Outcome

AIMTo study the effects of bone marrow MSCs transplantation on the apoptosis of alveolar wall cells and the expression of Bcl-2 and Bax of lung tissue in papain and Co60-induced pulmonary emphysema rats.

METHODSFemale Lewis rats were randomly divided into three groups: control group, emphysema group, emphysema + MSCs transplantation group. Rats were sacrificed at days 14 and 28 after treatment. Morphologic analysis of the lung tissue was performed. The apoptosis of the lung cells was assessed by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. The expression of Bcl-2 and Bax were determined by immunohistochemical staining.

RESULTSEmphysematous changes of the lung tissue were observed in emphysema group and emphysema + MSCs transplantation group. However, the emphysematous change in emphysema + MSCs transplantation group was improved compared with the emphysema group. There was significant difference in the number of alveolar counted per unit area (MAN), mean alveoli area (MAA) and mean linear interval(MLI) between emphysema group and emphysema + MSCs transplantation group. The apoptotic index of the alveolar wall cells in emphysema + MSCs transplantation group was less than that in the emphysema group. The percentage of Bcl-2 positive cells in emphysema + MSCs transplantation group was significantly higher than that in the emphysema group. The percentage of Bax positive cells in emphysema + MSCs transplantation group was significantly lower than that in the emphysema group. The ratio of Bcl-2/Bax of emphysema + MSCs transplantation group was significantly higher than that in the emphysema group.

CONCLUSIONBone marrow MSCs transplantation inhibits the apoptosis of alveolar wall cells, upregulates the expression of Bcl-2 and downregulates the expression of Bax. This may be part of the reason that bone marrow MSCs transplantation improves the papain and Co60-induced pulmonary emphysema.

Animals ; Apoptosis ; Bone Marrow Transplantation ; Cells, Cultured ; Cobalt Isotopes ; adverse effects ; Female ; Lung ; cytology ; Mesenchymal Stem Cell Transplantation ; Papain ; adverse effects ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; Pulmonary Alveoli ; drug effects ; pathology ; radiation effects ; Pulmonary Emphysema ; chemically induced ; metabolism ; pathology ; surgery ; Rats ; bcl-2-Associated X Protein ; metabolism

OBJECTIVETo evaluate the effect of single lung transplantation with concomitant contralateral lung volume reduction surgery (LVRS) for the management of end-stage emphysema.

METHODSA 46 year-old patient with end-stage emphysema received right lung transplantation and LVRS through the bilateral anterior-lateral intercostal incisions simultaneously.

RESULTSHyperinflation of the native lung or mediastinal shift did not occur after the operation, and the transplanted right lung dilated well without suppression. Acute rejection was not observed and the patient weaned from tracheal intubation 60 h after operation and from ventilator 108 h postoperatively. Persistent air leak occurred after LVRS but closed after instillation of hyperosmotic glucose. The patient was discharged 45 days after operation with significantly improved pulmonary function and normal life.

CONCLUSIONSingle lung transplantation with concomitant contralateral lung volume reduction for emphysema eliminates such complications of single lung transplantation as native lung hyperinflation, mediastinal shift, excessive suppression of the transplanted lung and hemodynamics instability, and can improve the success rate of the operation.

Combined Modality Therapy ; Humans ; Lung ; pathology ; surgery ; Lung Transplantation ; methods ; Male ; Middle Aged ; Pulmonary Emphysema ; pathology ; surgery ; Treatment Outcome

Spontaneous pneumothorax is rarely occurred as an initial sign of primary lung cancer. As a lot of these cases have already advanced, even then surgical resection is performed, the prognosis is often undesirable. We happened to find a ruptured cavity on a 65-year-old male patient who had suffered from pulmonary tuberculosis in the past, while performing VATS bullectomy for simple spontaneous pneumothorax. Then, as a result of frozen biopsy, it was diagnosed as squamous cell cancer. Because the tumor was infiltrated from the upper lobe into the lower lobe passing by fissure, we should remove by pneumonectomy and the pathologic stage was found stage I (T2N0M0). When we made an follow-up observation for one year and a half, there was neither relapse nor complication. When there appears spontaneous pneumothorax to the high risk group for lung cancer who were smokers over forty-year old, with chronic bronchitis or pulmonary emphysema, it needs to have a closer observation on a base lung disease such as lung cancer through chest CT, and it is also necessary to make more active approach by performing the surgical operation through a thoracoscopy when there is a continued air release.
Aged ; Biopsy ; Bronchitis, Chronic ; Follow-Up Studies ; Humans ; Lung Diseases ; Lung Neoplasms* ; Lung* ; Male ; Neoplasms, Squamous Cell ; Pneumonectomy ; Pneumothorax* ; Prognosis ; Pulmonary Emphysema ; Recurrence ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary