Multilocular thymic cysts (MTC) are acquired multilocular cysts caused by inflammation. The rarity of such lesions and a lack of recognition make diagnosis and treatment difficult. Herein, we present our experience with a multilocular mediastinal cyst that resulted in the development of thymic cancer with metastasis over a period of 13 years. Computed tomography findings revealed an anterior mediastinal mass that was suspected to be an MTC in a 49-year-old man. The mass shrank gradually over a period of 7 years; however, growth was observed at 10 years after initial detection. At 13 years after detection, thymic carcinoma with multiple lung metastases was diagnosed. Resection was recommended during the follow-up period, but the patient refused treatment. A multilocular wall and location are factors that indicate MTC. However, even if a definitive diagnosis is not made, resection of multilocular anterior mediastinal cysts should be considered as determining the preoperative diagnosis is difficult. Nevertheless, our case suggests that the coexistence of tumors with cysts is possible, and the potential for malignant tumor development exists. A multilocular mediastinal cyst suspected as multilocular thymic cyst shrank over a period of 7 years; however, thymic cancer with lung metastasis developed 13 years after initial detection. Resection should be considered for multilocular mediastinal cysts, due to the challenges they pose in preoperative diagnosis, the potential for coexisting tumors with cysts, and the risk of malignant tumor development.image

Introduction and importance: Thrombosis in the pulmonary vein stump (PVS) after lung resection has been reported as a cause of cerebral infarction (CI). However, there is limited research focusing on thrombosis in the PVS. Although anticoagulant therapy is performed in clinical settings, the optimal duration of anticoagulant therapy is not established. In addition, no case leading to CI after withdrawal of the anticoagulant therapy has been reported. Case presentation: An 81-year-old woman with lung cancer underwent left lower lobectomy. Since a thrombus was detected in the PVS 6 months after the operation, anticoagulant therapy was started. The thrombus disappeared 1 month later, and the medication was discontinued. However, only 23 days after discontinuation, the patient developed CI. Clinical discussion: This case was considered as cardiogenic CI due to a thrombus in the PVS because of the presence of the past thrombus, the distribution of infarction, and the absence of atrial fibrillation. The length of PVS in this case was longer than that reported previously, which could have caused turbulence and congestion leading to thrombogenesis. As long as patients have a long neck PVS, there might be a potential risk of thrombosis. Conclusion: We must recognize the risks associated with the discontinuation of anticoagulant therapy for thrombosis in PVS even after thrombus dissipation. Highlights:

Introduction: Minimally invasive video-assisted thoracic surgery (VATS) for lung cancer has become a widely used approach. However, postoperative pulmonary complications (PCs) such as pneumonia, atelectasis, and lung fistula remain significant challenges, particularly in older adult patients with multiple comorbidities. The 6-minute walk test (6MWT) has been suggested as a predictor of postoperative outcomes in various surgical settings, but its relationship with postoperative complications following VATS lobectomy for lung cancer has not been thoroughly explored. The aim of this study was to determine if preoperative 6MWD predicted the occurrence of 30-day PCs among patients undergoing VATS lobectomy for non-small-cell lung cancer. Methods: This retrospective study examined 66 patients who underwent VATS lobectomy for lung cancer. Participants were categorized into two groups: those with postoperative pulmonary complications (n = 11) and those without (n = 55). The research period was from January to September 2022. The preoperative 6MWT distance, along with other clinical and demographic factors, was assessed to determine its predictive value for postoperative complications. Multivariate logistic regression analysis was performed to identify significant predictors. Results: The study found that preoperative 6MWT ≤ 450 m was a significant predictor of postoperative pulmonary complications (odds ratio: 5.674, 95% CI: 1.206–26.684, p = 0.028). Conclusions: The preoperative 6MWT distance is a useful predictor of postoperative pulmonary complications in patients undergoing VATS lobectomy for lung cancer. Patients with a 6MWT ≤ 450 m may be at higher risk for complications such as pneumonia, atelectasis, and lung fistula. Incorporating preoperative 6MWT as a risk stratification tool could help guide clinical decisions and rehabilitation efforts to improve postoperative outcomes in this patient population.

Background: Silicone stents are options for airway stenosis or obstruction. Generally, silicone stent placement needs rigid bronchoscopy, but manipulation of a rigid bronchoscope has technical difficulties in some cases. The objective of this clinical case report is to highlight silicone stent placement with a rigid bronchoscope successfully achieved by changing the insertion from the mouth to the tracheostoma in a patient with postpneumonectomy syndrome. Case presentation: A 47-year-old man underwent right-side pneumonectomy 30 years previously, and he had an intubation tube inserted through a tracheostoma for 29 years to maintain the lumen for bronchial stenosis due to postpneumonectomy syndrome. A granuloma grew at the distal end of intubation tube, and he had labored breathing with stridor. Rigid bronchoscopy for silicone stent placement via the mouth failed because of airway curvature. We sequentially tried rigid bronchoscopy via the tracheostoma as an alternative, and we could easily insert the scope into the left secondary carina and place the silicone stent. Conclusion: Although strong airway curvature with tracheostomy is an uncommon situation, we succeeded silicone stent placement using a rigid bronchoscope via the tracheostoma. Insertion of a rigid bronchoscope via the tracheostoma instead of via the mouth could be an option.

Pulmonary vascular invasion is a well-recognized feature of advanced lung cancer and is associated with poor prognosis. Vascular invasion usually refers to either microscopic invasion into small vessels or direct invasion of great vessels; however, longitudinal subintimal spread within the pulmonary artery has not been reported. We describe the case of a 77-year-old woman with a pulmonary nodule followed for two years, which enlarged to 23 mm with cavitation. A right upper lobectomy with mediastinal lymph node dissection was performed. Histopathology showed that the tumor was predominantly adenocarcinoma. In addition, longitudinal invasion was identified beneath the intima of the pulmonary artery, located between the lumen and elastic fibers without extension into the lumen or outside the vessel wall. Notably, in this subintimal invasive area, the central portion consisted of adenocarcinoma, whereas squamous differentiation was confined to the surrounding margins. The primary nodule measured 2.5 cm, but the total extent of subintimal invasion was 6 cm. The pathological stage was pT3N0, stage IIB. This case demonstrates a previously unreported pattern of pulmonary artery invasion by lung adenocarcinoma with characteristic marginal squamous differentiation, expanding the spectrum of vascular invasion in lung cancer.