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Masafumi Kawamura



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    EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.15-23 - Cardiac Tamponade Caused by a Type A Thymoma: A Case Report (Now Available) (ID 404)

      08:00 - 18:00  |  Author(s): Masafumi Kawamura

      • Abstract
      • Slides

      Background

      Thymomas, the commonest neoplasm of the anterior mediastinum, are characteristically asymptomatic for prolonged periods. Most patients with disseminated disease have significant signs and symptoms such as chest pain or discomfort, dyspnea, and superior vena cava syndrome. Hemorrhagic pericardial tamponade is an uncommon initial manifestation and it is particularly rare for a thymoma to present with pericardial tamponade. We here present a 73 year-old man who was admitted to our institution with fever and shortness of breath and diagnosed with hemorrhagic pericardial tamponade resulting from a Type A thymoma.

      Method

      The patient presented to our emergency department in a stable condition and reported no previous trauma or muscular weakness. Chest computed tomography (CT) showed a cardiac effusion, an anterio-superior mediastinal 40×39×38 mm mass and enlarged mediastinal lymph nodes (image)image tamponade thymoma 2.png. After a hemorrhagic pericardial effusion had been drained, PET-CT performed to further investigate the mediastinal mass showed increased uptake in the mediastinum and right gluteus maximus muscle. Examination of a needle biopsy from the right gluteus maximus muscle mass revealed schwannoma. We therefore suspected the mediastinal mass was a metastatic schwannoma and performed VATS thymectomy combined with partial pericardiectomy.

      Result

      Histopathological evaluation of the operative specimen revealed a Type A thymoma that was T3 (cardiac) M1aN0 pStage IVa and Masaoka-Koga stage III. The tumor had invaded the cardiac structures. The patient was discharged on the eighth postoperative day. Radiation therapy (50Gy/25Fr) was started three months later. A chest CT taken 9 months postoperatively did not reveal any metastasis.

      Conclusion

      We here present a remarkable case of Type A thymoma extending into the pericardium and causing cardiac tamponade that was successfully resected after evacuating a hemorrhagic pericardial effusion.

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    EP1.17 - Treatment of Early Stage/Localized Disease (ID 207)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.17-07 - Partial Anomalous Pulmonary Venous Connection Found During a Lobectomy for Lung Cancer (Now Available) (ID 1692)

      08:00 - 18:00  |  Author(s): Masafumi Kawamura

      • Abstract
      • Slides

      Background

      Partial anomalous pulmonary venous connection (PAPVC) is an uncommon congenital anomaly and asymptomatic in most cases. According to previous reports, PAPVC found during a lobectomy for lung cancer is rare.

      Method

      A 76-year-old man who was asymptomatic, was referred to our hospital for an abnormal shadow found in the right upper lobe of the lung on computed tomography (CT) scan. A preoperative thoracic plane CT showed a small nodule in the right lobe. The contrast-enhanced CT for evaluating vascular system was not tested due to his renal dysfunction.

      Result

      Right upper lobectomy and mediastinal node dissection was performed without any surgical complications. An irregular vascular access was found intraoperatively that the one of superior pulmonary vein (V1) didn’t drain into the left atrium but the superior vena cava. The pathological diagnosis of the right lung tumor was adenocarcinoma, pT1bN0M0 stgeIA-2. The postoperative course was uneventful and echocardiography after surgery showed normal cardiovascular activity.

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      Conclusion

      It is possible that PAPVC of a single anomalous pulmonary vein with an intact atrial septum may not be clinically important. However, when the PAPVC is located in a different lobe, major lung resection (especially pneumonectomy) for lung cancer can result in fatal acute right heart failure due to increased shunting through the PAPVC. Therefore, the preoperative discovery of asymptomatic PAPVC may be very important for patients with planned lung resection. We must carefully interpret the findings of the existing architectural structure, including pulmonary artery, vein, or bronchus, as well as a lung tumor on the CT.

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