We aimed to investigate if Computed tomography (CT) attenuation values can help improve the identification of age-related changes in the thymus. We assessed CT images of 405 patients aged 0 to 80 years. We measured the area of the anterior mediastinum at the level of the carina and its average CT attenuation value. We evaluated the thymic area, the ratio of the thymus area to the total thoracic area, and the CT attenuation value. Additionally, we evaluated changes in the thymus area in the 0 to 13-year age group. The area of the thymus decreased from birth to the middle 20s. After the middle 20s, the area tended to increase and plateau till after 50 years of age. The ratio of the thymic area to the thoracic area decreased from age 0 to 20 years, but remained stable after 20 years of age. The CT attenuation values were stable from birth to puberty, decreased after puberty, and were stable again in the late 50s and beyond. The thymus of children showed mass formation, but the shape changed with age. No significant differences in the CT attenuation value were found across underlying conditions for the 0 to 13-year age group. The decrease in the CT attenuation values, observed with advancing age, reflects adipose degeneration of the thymus, indicating that by the late 50s, thymic tissue is replaced completely by adipose tissue. Our data suggest that adipose degeneration of the thymus begins after puberty and advances with age.

It is important to distinguish tumour recurrence from other conditions that could show high accumulation on 18F‐fluorodeoxyglucose‐positron emission tomography (FDG‐PET). We describe the case of a 78‐year‐old woman who underwent partial resection of the left lower lung lobe for carcinoid treatment 20 years previously. Five years earlier, chest radiography revealed an abnormal shadow, and chest computed tomography (CT) showed partial atelectasis in the left S8. Periodical CT showed that the atelectasis had developed into a mass. The patient was referred to our hospital. A mass of 45 mm diameter was detected on CT and it had a maximum standardized uptake value of 8.91 on FDG‐PET. We suspected recurrence and performed surgery. Pathological examination revealed epithelioid cell granuloma (maximum diameter, 25 mm) with necrosis. Tissue culture showed no evidence of Mycobacterium tuberculosis . However, serum anti‐MAC antibody level was elevated, suggesting epithelioid cell granuloma caused by non‐tuberculous Mycobacterium infection.

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Background Granulosa cell tumors (GCTs) are uncommon sex cord-stromal ovarian neoplasms. We report a case of GCT presenting in the chest, 18 years after oophorectomy for ovarian cystadenocarcinoma. Case presentation A 63-year-old female was admitted to our hospital for evaluation of a right hilar lesion. Subsequent abdominal and pelvic computed tomography and brain magnetic resonance imaging were unremarkable. Eighteen years earlier, the patient had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy at another institution for a uterine myoma, with the pathological findings indicating a uterine myoma, dermoid cyst of the right ovary, and serous cystadenocarcinoma and endometrioid adenoacanthofibroma around hemorrhagic cyst of the left ovary. No indication of a granulosa cell tumor (GCT) was present in either ovary. As such, diagnostic video-assisted thoracoscopic surgery was performed, revealing a well encapsulated tumor located next to the inferior pulmonary vein and small, disseminated lesions on the chest wall and diaphragm. Thereafter, we performed resection of the main tumor in its entirety and the disseminated lesions to the extent possible. Pathological examination of the resected specimens revealed a neoplasm characterized by sheets and islands of closely packed tumor cells exhibiting small follicles (Call-Exner bodies) surrounded by cells with pale, uniform nuclei, typically observed in the microfollicular pattern of adult GCT. Although the etiology of occurrence of intrathoracic granulosa cell tumor is unknown, we assumed that the neoplasm oriented from radiologically undetectable peritoneal seeding at the time of her previous surgery, with subsequent migration through the diaphragm. Over the next 10 years, she received chemotherapy with cyclophosphamide, adriamycin, and cisplatin; other combination chemotherapy; single-agent chemotherapy; and palliative radiotherapy. She died from malignant pleuritis and peritonitis 10 years after thoracoscopic surgery. Conclusions We have reported a case of a 63-year-old female with a history of ovarian cystadenocarcinoma who underwent resection of a pleural neoplasm, which turned out to be a granulosa cell tumor. This possibility resulted from dissemination of a previous abdominal lesion.

ObjectiveImproving quality of life (QOL) after surgery is very important. Recently, preoperative anxiety has been suggested to predict postoperative health-related (HR) QOL, however the accuracy of anxiety measurement remains problematic. We examined the relationship between preoperative anxiety level and postoperative HRQOL using qualitative and quantitative assessment of anxiety.MethodWe used a detailed anxiety assessment to quantitatively investigate preoperative anxiety as a predictor of postoperative HRQOL in lung cancer patients. Fifty one patients who underwent surgery for lung cancer were included. They were assessed four times: on admission, on discharge, 1 month after surgery, and 3 months after surgery. Anxiety was measured separately as “state anxiety” and “trait anxiety” using the State–Trait Anxiety Inventory, and HRQOL was measured using the EuroQol 5 dimension 5-level.ResultsThe HRQOL decreased at discharge and gradually recovered over time, reaching the same level at 3 months after surgery as at admission. HRQOL score was lower at discharge than at pre-surgery and 3 months after the surgery (p < 0.0001 each), and the score at 1 month after the surgery was lower than at pre-surgery (p = 0.007). In addition, multiple regression analysis showed that HRQOL at discharge was associated with “state anxiety” rather than “trait anxiety” at admission (p = 0.004).ConclusionThis study identifies the types of anxiety that affect postoperative HRQOL. We suggest that postoperative HRQOL on discharge may be improved by interventions such as psychological or medication treatment for preoperative state anxiety if identified preoperative state anxiety can be managed appropriately.