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Twenty one children with asthma aged 1.0-10.5 years (mean (SD) 3.3 (2.5) years) were admitted to the hospital to evaluate pulmonary right middle lobe or lingular collapse lasting one to 12 months (mean (SD) 4.4 (3.8) months). Seven children had mild asthma and were treated with inhaled beta 2 agonists as needed. Nine had moderate asthma treated with either sodium cromoglycate or slow release theophylline. Five had severe asthma treated with inhaled steroids. Each child underwent fibreoptic bronchoscopy under local anaesthesia and a bronchoalveolar lavage. Differential cell counts of the lavage fluid revealed predominance of neutrophils in 12 patients (57%). In nine of these patients cultures grew pathogenic bacteria, mainly Haemophilus influenzae and Streptococcus pneumoniae. There was no correlation between the severity of asthma and a positive bacterial culture. There was also no correlation between the duration of the right middle lobe collapse and a positive culture. We conclude that longstanding right middle lobe collapse in asthmatic children is often associated with bacterial infection.

The experience with 45 patients with lung abscess over a three-year period at the University College Hospital (UCH), Ibadan, is presented. This study confirms the rarity of this disease among Nigerian children and its prevalence in young adults in the third and fourth decades of life. The most common presenting symptoms were purulent cough, chest pain, fever, and life-threatening hemoptysis which was the sole indication for emergency operation in 14 out of 16 patients who were treated surgically. The predominance of these abscesses in the right lung, especially in the superior segment of the lower lobe, supports the fact that aspiration of infected material, following depressed level of consciousness, esophageal obstruction, foreign bodies, and oral sepsis form the major causative factors in patients with lung abscess. The frequent association of sickle cell disease, bronchiectasis, hypertension, and pulmonary aspergilloma contribute significantly to the morbidity and mortality attendant to this disease in our environment. Twenty-nine patients were treated medically with five deaths and 16 patients were treated surgically with six deaths. The high operative mortality (37.5 percent) in this series was due to the extreme emergency conditions under which these patients were operated.

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Introduction

Primary leiomyoma of the lung is a rare benign tumor that usually presents as a solitary lesion predominantly in young females. Fewer than 100 cases have been reported. Common symptoms include fever, chronic cough, hemoptysis, chest pain, shortness of breath, and pneumonias.

Case presentation

A 34-year-old, non-smoker female who presented with recurrent pneumonias. She was found to have a primary leiomyoma of the right middle lobe. This was treated by right middle lobectomy. 6-month follow up showed patient doing well without evidence of residual disease on computerized tomography.

Conclusion

Primary pulmonary leiomyoma is a rare tumor distinct from benign metastasizing leiomyoma. Histologic features include absence of mitotic count, low cellularity, lack of cytologic atypia and pleomorphism. Treatment is by conservative surgical resection and carries a favorable prognosis.

From July 1981 to January 1983 502 adults were treated for lobar or segmental pneumonia in a general hospital in Northern Zambia. Consolidation was present in either the right or the left lower lobe in 78.8%, the right middle lobe in 10.2% and either the right or the left upper lobe in 10.7%. Penicillin treatment failed to give an improvement in 10.7%, many of whom recovered after receiving either gentamicin or kanamycin. A high risk of death was associated with an age of 65 years or over, absence of pyrexia, absence of a leucocyte response, disease affecting multiple lobes, irreversible hypotension, underlying neoplasm, and failure to respond to penicillin treatment (p less than 0.001 in all cases). Penicillin remains the initial treatment of choice for lobar pneumonia in rural central Africa. Mortality can probably be reduced by inpatient treatment of as many patients with pneumonia as local circumstances allow, and by adding broad spectrum treatment in patients who show no improvement after 48 hours of penicillin treatment.

Chyloptysis, in the context of middle lobe syndrome, and chylothorax are rare clinical entities. They are reported in the medical literature mostly as case reports, but never together in the same patient. The present report describes the case of a 34-year-old woman who presented with chyloptysis associated with recurrent right middle lobe syndrome since she was 20 years of age, and eventually underwent right middle lobectomy. A few weeks postoperatively, she developed a right-sided chylothorax, which was refractory to medical therapy, and was successfully treated with thoracic duct ligation. She has been symptom-free for two years postsurgery.

A 58-year-old female patient presented to the hospital with hearing loss. In the chest radiography obtained before her ear surgery, volume decrease in the right hemithorax, elevation of the right diaphragm, and increase of ventilation in the right lung were detected. At the thorax CT-CT angiography, hypoplasia of the main pulmonary artery and its branches and arteriovenous malformation localized in the middle lobe of the right lung were detected. Thus, diagnosis of Swyer-James-Macleod syndrome associated with right lung middle lobe hypoplasia and arteriovenous malformation was made. This kind of association has not been reported earlier, so we are presenting it in the light of the literature knowledge.

Background

Pulmonary hyalinizing granuloma is an unusual condition, characterized by fibrosing nodules, consisting of the either unilateral or bilateral central whorled deposits of lamellar collagen hyaline. Although the etiology is uncertain there are evidences that suggest an autoimmune origin. Clinically and with imaging techniques it may be minic primary or metastatic carcinoma or nodular amyloidosis.

Patients and methods

We report case of 74 years old woman who admitted in our hospital with cough, dyspnea and chest pain. A CT scan of the chest revealed a mass located in the middle lobe of the right lung. The patient underwent thoracotomy for surgical excision of the mass macroscopic examination of the excised lobe revealed a well-circumscribed firm, grayish-white mass, measuring 3.1 cm × 2 cm × 1.3 cm. The sections were examined with H+E, PAS, and Congo-Red and followed by immunohistochemical study for Amyloid A and P, CD138, κ and λ light chains.

Results

The microscopic examination with H+E showed that the lung parenchyma presented extensive hyaline fibrosis PAS positive, areas of calcification and foci of bone metaplasia, accompanied by an inflammatory reaction. Congo-Red stain was positive but screening for birefringent material under polarized light was negative. Amyloid A and P were negative. The plasma calls were positive for CD138, κ and λ light chains. These histological findings were consistent with diagnosis of pulmonary hyalinizing granuloma.

Conclusions

The pulmonary hyalinizing granuloma should be considered in the differential diagnosis of pulmonary nodules or masses, even when they are cavitary or contain calcifications.

Objective

To analyze the characteristics and technical difficulties of complete video-assisted thoracoscopic surgery (c-VATS) for treatment of pulmonary sequestration operation.

Methods

25 cases of c-VATS lobectomy for intrapulmonary sequestration performed between January 2009 and May 2012 were reviewed. The 25 patients included 13 (52%) males and 12 (48%) females, with a mean age of 34.7 years (range, 16-62 years). Preoperative imaging by CT scan and three-dimensional reconstruction of abnormal blood vessels diagnosed 19 cases as pulmonary sequestration, misdiagnosed 1 case as pulmonary cyst syndrome, 4 cases as bronchiectasis and 1 case as benign tumor.

Results

All the patients underwent c-VATS excision, 16 in the left lower lobe, 7 in the right lower lobe, 1 in right middle lobe and 1 extralobar pulmonary sequestration. Vascular abnormality was observed intraoperative including the thoracic aorta in 20 cases, abdominal aorta in 2 cases, phrenic arteries and intercostal artery in 1 cases and thoracic aorta combined with abdominal aorta in 1 case. No conversion to open was achieved in all cases. The mean operating time was 114.2 mins (range, 78-156 mins), the mean blood loss was 228 mL (range, 50-3,000 mL), the mean duration of chest drainage was 3.2 days (range, 2-7 days) and the mean length of post-operative hospital stay was 6.6 days (range, 3-13 days). There was no mortality, without significant postoperative complications, were cured and discharged. Patients were followed up for 2-32 months, mean 21.4 months, with no recurrence.

Conclusions

c-VATS is feasible, effective, and safe in treatment of pulmonary sequestration. It is worthy of clinical application.

Intracranial pial arteriovenous fistula (AVF) is a rare cerebrovascular malformation, which has a single or multiple arterial connections to a single venous channel without intervening nidus, and is different from arteriovenous malformation (AVM). We report on a case of a surgically treated pial AVF. A 15-year-old girl with an altered mental state was brought to our hospital. Computed tomography (CT) showed a subcortical hematoma of approximately 24 ml in her right temporal lobe. Cerebral angiography showed an AVF supplied by the right middle cerebral artery with early drainage into the Sylvian vein and the vein of Labbe. She underwent surgical treatment with feeding artery obliteration using a clip and hematoma removal. The patient was discharged without neurologic deficits. Despite the rarity of pial AVF, for correct diagnosis and treatment, neurosurgeons should recognize this condition. Pial AVF can be managed simply by disconnection of the shunt by surgery or endovascular treatment, and a good result can be achieved.

Seven patients with giant cavernous hemangioma of the liver were treated surgically with success at Pusan Gospel Hospital, Kosin Medical College, Pusan, from 1980 through 1989. They were 3 males and 4 females, and their ages ranged from 6 to 59 years. The tumors were located on the right lobe of the liver in 5 patients and on the left lobe in 2. The lesions were solitary in all patients, and their sizes varied from 4cm to 15cm in diameter. All patients underwent hepatic resection: 1 right hepatic lobectomy and 4 partial resections for tumors on the right lobe, and 1 left lobectomy and 1 left lateral segmentectomy for tumors on the left lobe. There was no surgical death, but 1 patient had a postoperative complication: multiple stress ulcers on the stomach and ileum. The pathologic diagnosis was cavernous hemangioma in all cases. In the long-term follow-up, there was no recurrence of preoperative symptoms in any patient.

Purpose

Endobronchial tuberculosis (EBTB) presenting as right middle lobe syndrome (RMLS) is an uncommon clinical condition. We investigated the clinical characteristics in patients with EBTB presenting as RMLS.

Patients and Methods

We retrospectively reviewed the records of 22 patients with EBTB presenting as RMLS who were diagnosed at our hospital from 2003 to 2006.

Results

Its occurrence was more common in females than males (F, 18; M, 4). The mean age was 70.3 ± 8.5 years, and 17 patients were above the age of 65 years. Cough with sputum was the most common manifestation and 2 patients were asymptomatic. In bronchoscopic analysis, the most common finding was edematous-type EBTB, which was found in 15 patients, followed by actively caseating type in 6 and tumorous type in 1. Acid-fast bacilli (AFB) staining for bronchial washing fluid was positive in only 5 patients: 1 with edematous type and 4 with actively caseating type. Bronchoscopic biopsy showed chronic granulomatous inflammation in 16 patients. Follow-up chest X-ray after treatment showed complete disappearance of the lesion in 2 patients, more than 50% improvement in 5, less than 50% improvement in 5, and no change of lesion in 4.

Conclusion

Edematous-type EBTB was the most common type of EBTB presenting as RMLS, and it usually occurred in elderly patients. Culturing for mycobacterium and histologic examination by bronchoscopy are necessary for proper diagnosis in these patients.

Aspergilloma and invasive aspergillosis coexisting with multidrug resistant Mycobacterium tuberculosis (MDR-TB) in the same patient is a rare entity. We report a 50 year old South Indian woman, a diabetic, who presented to us with complaints of productive cough and hemoptysis for the past 2 months. She was diagnosed to have pulmonary tuberculosis 2 years ago for which she took irregular treatment. Lung imaging showed features of a thick walled cavity in the right upper lobe with an indwelling aspergilloma. She underwent a right lung upper lobe resection. Biopsy and culture of the resected specimen showed the coexistence of Aspergillus fumigatus and multi-drug resistant Mycobacterium tuberculosis. 2 blood cultures grew Aspergillus fumigatus. She was successfully treated with Voriconazole and anti tuberculous therapy against MDR-TB.

Introduction. Agenesis of the right lobe of the liver is a rare finding and was defined as the absence of liver tissue on the right side, with preservation of the middle hepatic vein, without previous disease or surgery. It is usually an incident finding reveled by imaging exams or during abdominal surgery. Case Report. A 32-year-old male patient was admitted to the hospital for abdominal discomfort and loss of appetite. Imaging studies revealed the absence of the right hepatic lobe and hypertrophied left hepatic segments. Discussion. Anomalies of hepatic morphology are rare and correspond to developmental defects during embryogenesis, are a rare diagnosis, and are generally diagnosed incidentally based on imaging. Agenesis or hypoplasia of the right lobe may predispose the patient to the development of portal hypertension and esophageal varices. Surgical knowledge of such anatomical agenesis is necessary for surgical planning, for the appropriate identification of intraoperative surgical findings, and for the design of the postoperative approach to therapy. Conclusion. Agenesis of the right hepatic lobe is a rare condition. We want to highlight the importance of understanding the condition. Surgeons must recognize the entity in order to deal appropriately with the findings.

Abstract

We report a 32-year-old Outer Mongolian man, with plasmablastic lymphoma (PBL) primarily occured in the central nervous system and diagnosed by surgical resection. This patient appeared headache and Magnetic resonance imaging (MRI) showed multiple lesions in the right cerebral hemisphere including the right frontal-parietal lobe and right basal ganglia and the left cerebellum, he was diagnosed as lymphoma by stereotactic biopsy in January 2009 in local hospital, and was given radiotherapy 33 times after the biopsy. The patient was admitted to The Military General Hospital of Beijing PLA., Beijing, P.R. China on March 9th, 2011, with chief complaints of right limbs convulsioned suddenly, then fell down and lose of his consciousness, then awoke after 4 to 5 minutes, with symptoms of angulus oris numbness and the right upper limb powerless ten days ago.

MRI of the brain revealed a well-defined hyperdense and enhancing mass in the left frontal-parietal lobe, the meninges are closely related, there was extensive peritumoural edema noted with pressure effects, as evident by effacement of the left lateral ventricles and a 0.5 cm shift of the midline to the right side.

Surgical resection showed markedly atypical, large singly dispersed or cohesive proliferation of plasmacytoid cells with frequent abnormal mitoses and binucleation, some neoplastic cells were large with round or oval nuclei and showed coarse chromatin and smaller or unapparent nucleoli, some neoplastic cells with prominent nucleoli, apoptosis and necrosis were often presented. Immunohistochemistry staining and gene rearrangement together with other supportive investigation confirmed the diagnosis of primary central nervous system plasmablastic lymphoma. A month later, he was started on chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, leurocristime and prednisone) for a week. Other supportive treatment was provided for symptomatic epilepsy. The patient regained muscle strength in both upper limbs and right lower limb and the symptomatic epilepsy was controlled after two weeks. Then the patient was discharged. Follow-up data shows the patient to be alive eleven months after discharge.

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Mycobacterium kansasii is one of the most common cause of pulmonary diseases due to nontuberculous mycobacteria. We investigated the changing in the number of isolation of M. kansasii and the clinical characteristics of M. kansasii pulmonary disease in Korea. Through searching the database of the Korean Institute of Tuberculosis, we identified the cases of isolated M. kansasii from 1992 to 2002. The number of M. kansasii isolation had increased from once in 1992 to 62 in 2002. Fifteen patients with M. kansasii pulmonary disease were identified during the period January 1997 to December 2002. Twelve patients (80%) were male and fourteen (93%) were from highly industrialized areas. The most common symptom was a cough. Seven patients (47%) had a cavitary lesion and right upper lobe was most commonly involved. Patients responded well to isoniazid and rifampicin based regimens both bacteriologically and radiographically. In conclusion, M. kansasii isolation has increased, especially in highly industrialized areas, as well as other nontuberculous mycobacteria in Korea.

Congenital cystic adenomatoid malformation (CCAM) is an uncommon, nonhereditary anomaly caused by arrest of lung. Patients with CCAM may present with respiratory distress as newborns, or may remain asymptomatic until later in life. CCAM type I is rarely found in association with bronchial atresia (BA) in adults; we present such a case. Case: A 54-year-old female presented with chronic cough and blood-tinged sputum. Physical examination and laboratory tests were unremarkable. Chest radiographs and a CT scan of the chest showed multiple large air-filled cysts consistent with a CCAM in the right lower lobe, and an oval-shaped opacity in the distal right middle lobal bronchus. Based on the radiologic findings, right middle lobectomy and a medial basal segmentectomy of the right lower lobe were performed via a thoracotomy. These lesions were consistent with Stocker's Type I CCAM and BA in the different lobes.

Background

It is common ground that immunohistochemistry’s contribution in neoplasm’s origin identification is invaluable. However, in some cases there seem to exist certain limitations raising differential diagnosis problems.

Patients and methods

A young 23-year old woman, who was recently pregnant and breastfeeding, presented to our hospital with dyspnea and superior vena cava syndrome. A month ago she suffered from upper respiratory tract infection, which was treated with antibiotics. Axial computed tomography showed several mediastinal masses and right lower lobe lung invasion. This was followed by bronchoscopy and samples were taken for biopsy.

Results

Upon histological evaluation a malignant neoplasm with extensive necrosis was revealed. Diffuse distribution of oval, middle to large size cells, with conspicuous nucleoli and mitoses, tend to lead to the diagnosis of a lymphoproliferative neoplasm. During to gradual and extensive immunohistochemical examination, the neoplastic cells were found negative to stains specific for hemopoietic system diseases as well as other malignant neoplasm such as sarcoma, mesothelioma, germ cell tumor, melanoma and neuroendocrine carcinoma. On the other hand, they were strongly positive for p63 (squamous cell differentiation index), CD138 and only weak and focally for keratins (CKAE1/AE3, CK8/18, CK7, CK5/6). Morphological and immunohistochemical findings consisted with undifferentiated carcinoma, with squamous cell differentiation. The patient deceased 20 days later.

Conclusions

Neoplastic morphological features tend to lead to a correct diagnosis which should always be certified by immunohistochemical findings. However, in some cases immunohistochemistry’s role is diminished due to tumor specific factors as neoplastic cells’ poor differentiation or dedifferentiation and degenerative changes.

Introduction

Hughes-Stovin syndrome is a very rare disease with fewer than 30 cases reported in the literature. The disease is thought to be a variant of Behcet's disease and is defined by the presence of pulmonary artery aneurysm in association with peripheral venous thrombosis.

Case presentation

A previously healthy 23-year-old Saudi woman presented with massive hemoptysis a day prior to her admission to our hospital. She had a six-month history of recurrent fever, cough, dyspnea, and recurrent oral ulceration. Contrast-enhanced computed tomography scan of her chest and pulmonary angiogram demonstrated a single right-lower lobe pulmonary artery aneurysm. She underwent thoracotomy and right lower lobe resection. Her postoperative course was complicated by deep vein thrombosis. She also developed headache and papilledema, while a magnetic resonance imaging of her brain suggested vasculitis. Based on these clinical presentations, she was diagnosed and treated with Hughes-Stovin syndrome.

Conclusion

The majority of cases of Hughes-Stovin syndrome are reported among men, with only two cases occurring in women. A case of Hughes-Stovin syndrome occurring in a woman is presented in this report. She was treated successfully with multimodality treatment that includes surgery, steroids and cytotoxic agents.

Background

The appearance of multiple malignancies in the same patient is a relatively rare occurrence, which can either be synchronous or metachronous. The etiology is multifactorial and some of the factors involved in the pathogenesis of these conditions include genetic predisposition, immunodefiency, radiation therapy, chemotherapy and various infectious agents. We report the case of a patient with squamous cell lung cancer in whom non-Hodgkin lymphoma was accidentally found in paratracheal lymph nodes.

Patients and methods

A 68-year-old man, with a known history of squamous cell carcinoma of the right lung, presented to our hospital with persevering hemoptysis. An emergency right pneumonectomy and regional lymphadenectomy was performed. A tumor, measuring 6 cm, was found in the middle and lower lobe.

Results

Histological evaluation revealed a malignant neoplasm composed of nests of large-sized, pleomorphic and atypical cells in fibrous stroma, intercellular bridges, pearl formation and areas of necrosis. Histological findings consisted with well differentiated squamous cell carcinoma of the lung, with lymph node metastasis. During histological examination in most paratracheal lymph nodes a diffuse expansion of small-sized lymphoid cells was unexpectedly found. The immunohistochemical examination led us to the diagnosis of a non-Hodgkin lymphoma. The patient died 18 days after surgical operation.

Conclusions

The incidence of multiple primary malignancies is expected to increase due to the better screening methods, which are essential for carcinoma diagnosis and follow-up. Simultaneously, the progress in molecular biology contributes to further understanding of carcinogenesis.

Introduction

Hydrocarbon pneumonitis is an acute, intense pneumonitis resulting from aspiration of volatile hydrocarbon compounds with low viscosity and surface tension, most of which are members of the paraffin, naphthene and aromatic classes.

Case presentation

Six hours after participating in a party for teenagers, a 16-year-old boy developed dyspnea, cough, a fever (39°C) and chest pain. A chest radiograph showed infiltration in the right middle lobe. The patient reported alcohol abuse during the party and an episode of vomiting a few hours thereafter. He also reported practicing a fire-eating performance at the party using liquid paraffin, but was unaware of inhaling any of it. The radiographic infiltration was diagnosed as an aspiration pneumonia and he was treated at the local health center with antibiotics. Five days later, because of clinical deterioration, he was referred to a pulmonary clinic. A chest computed tomography scan was performed which showed consolidation with an air bronchogram in the right middle lobe and areas of atelectasis and ground glass opacities in the middle and lower right lobes. Spirometry revealed severe restriction of lung function. A bronchoscopy revealed inflamed, hyperemic mucosa. Bronchoalveolar lavage fluid revealed lipid-laden alveolar macrophages, which were detected by lipid staining, and neutrophilia. The patient was finally diagnosed with hydrocarbon pneumonitis and he was treated with systemic steroids and antibiotics. After 6 days of treatment there was complete clinical and significant radiologic regression.

Conclusion

Hydrocarbon pneumonitis should be included in the differential diagnosis of pneumonias. Recent exposure to volatile hydrocarbons provides a basis for clinical diagnosis, as symptoms and radiologic findings are not specific.

A non-smoking 77-year old gentleman of Indian origin was admitted with a 4-month history of intermittent night sweats, haemoptysis and 6 kg of weight loss. CT scan of thorax demonstrated a 2.5 cm mass in the right middle lobe with multiple small nodules within the right lung and confirmed the presence of mediastinal and hilar lymph nodes.

Fibreoptic bronchoscopy demonstrated a distorted right main bronchus, anterior shift of the right upper lobe and occlusion of the right middle lobe bronchus with a black necrotic ulcer. Mycobacterium tuberculosis was found in the bronchoalveolar lavage and histology demonstrated numerous fungal hyphae with a morphological appearance of zygomycetes within necrotic areas of tissue. Medical management with anti-fungal and anti-mycobacterial treatment was instigated as the patient's pre-existing IHD did not permit surgical intervention. Subsequently CT imaging following completion of therapy demonstrated improvement of the mass and a resolution of the associated nodules. The patient has been followed for 6 months to date and there has been no recurrence of symptoms. Recent bronchoalveolar lavage cultures have been negative for M. tuberculosis and zygomycetes.

Objective

To describe the radiologic findings of migrating lobar atelectasis of the right lung.

Materials and Methods

Chest radiographs (n = 6) and CT scans (n = 5) of six patients with migrating lobar atelectasis of the right lung were analyzed retrospectively. The underlying diseases associated with lobar atelectasis were bronchogenic carcinoma (n = 4), bronchial tuberculosis (n = 1), and tracheobronchial amyloidosis (n = 1).

Results

Atelectasis involved the right upper lobe (RUL) (n = 3) and both the RUL and right middle lobe (RML) (n = 3). On supine anteroposterior radiographs (n = 5) and on an erect posteroanterior radiograph (n = 1), the atelectatic lobe(s) occupied the right upper lung zone, with a wedge shape abutting onto the right mediastinal border. On erect posteroanterior radiographs (n = 6), the heavy atelectatic lobe(s) migrated downward, forming a peri- or infrahilar area of increased opacity and obscuring the right cardiac margin. Erect lateral radiographs (n = 4) showed inferior shift of the anterosuperiorly located atelectatic lobe(s) to the anteroinferior portion of the hemithorax.

Conclusion

Atelectatic lobe(s) can move within the hemithorax according to changes in a patient's position. This process involves the RUL or both the RUL and RML.

Introduction

Double primary bronchogenic carcinoma and papillary carcinoma of the thyroid are extremely rare. We describe the case of a patient who underwent surgical resection for these two cancers.

Case presentation

A 56-year-old man presented to our hospital complaining of a cough with blood-tinged sputum. A slowly growing mass in the left lobe of the lung had been noted for about 1 year. He underwent video-assisted thoracic surgery of the left lower lobe and mediastinal lymph node dissection through an 8 cm utility incision. Pathology revealed a well-differentiated adenocarcinoma and the dissected lymph nodes were negative for malignancy. He also complained of a mass in his neck, which had grown slowly for over 5 years. A computed tomography scan of the neck revealed a left thyroid mass compressing the trachea towards the right side. There was no cervical lymphadenopathy. A left thyroid lobectomy was performed and pathology revealed a papillary carcinoma. Thus, he underwent a second operation to remove the right lobe of the thyroid. He underwent subsequent adjuvant chemotherapy.

Conclusion

In a review of the literature, it appears that there has only been one previously reported case of these two cancers, which was in Japan. The relationship between these two cancers is still unclear, and more case reports are required to determine this relationship.

In a study of the lobar distribution of tumors in 250 consecutive cases of primary bronchial cancer, it was noted that 130 of the tumors originated in the upper lobes, 11 in the right middle lobe, and 49 in the lower lobes. Some 40 arose in the main bronchi, and most of the remainder were either “hilar” or unspecified in anatomic location.

There was no apparent correlation of the lobar site of these tumors with the lobar location of childhood pneumonic lesions as observed in another group of patients in the same hospital.

A 70-yr-old woman visited our hospital for shortness of breath. Chest CT showed ground glass opacity and traction bronchiectasis at right middle, lower lobe and left lingular division. Video-assisted thoracic surgical biopsy at right lower lobe and pathologic examination revealed mixed dust pneumoconiosis. Polarized optical microscopy showed lung lesions were consisted of silica and carbon materials. She was a housewife and never been exposed to silica dusts occupationally. She has taken freshwater snails as a health-promoting food for 40 yr and ground shell powder was piled up on her backyard where she spent day-time. Energy dispersive X-ray spectroscopy of snail shell and scanning electron microscopy with energy dispersive x-ray spectroscopy of lung lesion revealed that silica occupies important portion. Herein, we report the first known case of silicosis due to chronic inhalation of shell powder of freshwater snail.