Low-grade fibromyxoid sarcoma (LGFMS) is a rare sarcoma subtype that most commonly arises in young adults. This tumor typically presents in the deep soft tissues of the proximal extremities or trunk as a painless mass. Although the most common site of LGFMS metastasis is the lung, it is rarely the primary site. Here, we report a case of primary pulmonary LGFMS. A 22-year-old asymptomatic man was referred to our hospital for investigation of a lung mass that had been discovered incidentally. Computed tomography (CT) showed a well-defined mass 4.0 cm in diameter in the upper lobe of the right lung. Malignancy was suggested by focal uptake of 18F-fluorodeoxyglucose positronemission tomography (18-FDG-PET). Following surgery, postoperative histological analysis of the resected specimen demonstrated LGFMS based on histological and immunohistological findings. In particular, mucin 4 showed diffuse positivity in the spindle-shaped tumor cells. In conclusion, LGFMS can arise in the lungs, and physicians should consider this entity as a differential diagnosis for solitary lung mass in young adults.

Background: Fibrin glue effectively controls air leakage in lung surgery; however, allogenic fibrin glue cannot eliminate the risks of infection and allergy despite current sterilization methods. Autologous fibrin glue (AFG) could be a good alternative, but is not commonly used worldwide because of its limited availability and lack of evidence. Herein, we report clinical outcomes of AFG in thoracic surgery. Methods: We retrospectively analyzed patients who underwent lobectomies or segmentectomies betweenNovember 2016 and September 2017 in our institution. We used two types of AFGs. One was a partiallyautologous fibrin glue (PAFG), the components of which are largely autologous but which contains allogenic thrombin. The other was a completely-autologous fibrin glue (CAFG) which has no allogenic components.PAFG was used in the first half of the study period, after which CAFG was used from March 2017 onward.Patients who did not undergo AFG generation were categorized as the non-AFG group. The perioperative outcomes of the three groups were evaluated.Results: A total of 207 patients underwent lung surgery, including 118 lobectomies and 89 segmentectomies. Among them, 83 patients received PAFG, 94 received CAFG, and 30 received non-AFG.The mean postoperative drainage period was within a few days in each group (PAFG vs. CAFG vs. non-AFG: 3.23±3.91 vs. 3.16±4.04 vs. 3.17±4.16 days, respectively; P=0.405), and the incidence of postoperative prolonged air leakage was within an acceptable range (PAFG vs. CAFG vs. non-AFG: 13.3% vs. 12.8% vs.16.7%, respectively; P=0.821). Conclusions:The use of AFG is clinically feasible for patients who undergo lobectomies or segmentectomies. AFGs could be a viable alternative to conventional allogenic fibrin glues.

The lung is the organ most commonly affected by primary synovial sarcoma. Intratumoral calcification is less common in this organ versus soft tissue. Meanwhile, the presence of calcification in a lung nodule reduces the risk of lung cancer. Here, we report a case of pulmonary synovial sarcoma which manifested as a nodule with calcification, depicted on computed tomography (CT). A 52‐year‐old asymptomatic male was referred to Saitama Medical University International Medical Center and CT revealed a well‐defined nodule (1.8 cm), with punctate and eccentric calcification in the right lower lobe. Enhanced CT and 18F‐fluorodeoxyglucose positron‐emission tomography suggested a malignant tumor, and surgery was performed. Histology provided a preliminary diagnosis of monophasic spindle‐cell synovial sarcoma with hyalinized collagen bands and calcifications. Genetically, the presence of the SYT‐SSX2 fusion gene was consistent with the features of this disease. We conclude that primary pulmonary synovial sarcoma should be listed as a differential diagnosis for solitary pulmonary nodules with calcification.

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ObjectiveClinical feature of heart failure with improved ejection fraction (HFimpEF) remains to be fully elucidated. The present study investigated the association of clinical and echocardiographic parameters with the subsequent improvement of left ventricular ejection fraction (LVEF) in heart failure with reduced ejection fraction (HFrEF).MethodsFrom outpatients with a history of hospitalized for heart failure, 128 subjects diagnosed as HFrEF (LVEF <40%) on heart failure hospitalization were enrolled and longitudinally surveyed. During follow‐up periods more than 1 year, 58 and 42 patients were identified as HFimpEF (improved LVEF to ≥40% and its increase of ≥10 points) and persistent HFrEF, respectively.ResultsThere was no difference in age or sex between the two groups with HFimpEF and persistent HFrEF. The rate of ischemic heart disease was lower and that of tachyarrhythmia was higher in the HFimpEF group than in the persistent HFrEF group. At baseline (i.e., on heart failure hospitalization), LVEF did not differ between the two groups, but left ventricular systolic and diastolic diameters were already smaller and the ratio of early diastolic transmitral velocity to early diastolic tissue velocity (E/e′) was lower in the HFimpEF group. A multiple logistic regression analysis revealed that lower baseline E/e′ was a significant determinant of HFimpEF, independently of confounding factors such as ischemic heart disease, tachyarrhythmia, and baseline left ventricular dimension.ConclusionOur findings indicate that the lower ratio of E/e′ in the acute phase of heart failure onset is an independent predictor of the subsequent improvement of LVEF in HFrEF patients.